The protective role of education in white matter lesions and cognitive decline

Cognitive reserve, often reflected by education, may protect against cognitive decline linked to brain pathology. White matter lesions (WMLs), common in aging, are associated with the progression from healthy cognitive status (HC) to mild cognitive impairment (MCI). This study explores education's role, as a proxy for cognitive reserve, in moderating the relationship between WML burden and the HC to MCI transition. Data from the Alzheimer's Disease Neuroimaging Initiative (ADNI) were analyzed for 153 cognitively healthy adults. Participants were divided into two groups: one (n = 85) remained cognitively healthy for at least seven years, while the other (n = 68) progressed to MCI. WML volumes were assessed using MRI scans and analyzed with linear regression models including age, sex, and an intraction term between group status and education to examine moderation effects. Both WM-hyper and WM-hypo showed a similar pattern across analyses. A significant interaction between group and education for both WML types (WM-hyper: β = -0.097, p = 0.047; WM-hypo: β = -0.070, p = 0.037) was found, suggesting that among individuals who progressed to MCI, higher education was associated with lower WML burden.This suggest that education plays a protective role against white matter pathology among individuals at risk for cognitive impairment.