Higher Education Influences Stroop Performance in Non-Demented Older Adults: The Mediating Role of Resting-State...

Although extensive research has linked education to the Stroop effect, the neural mechanisms by which higher education influences Stroop performance in non-demented older adults remain unclear. This study investigated this relationship in 126 older adults from Qingdao, stratified into higher education (> 12 years) and non-higher education (≤ 12 years) groups. Demographic data and Stroop performance were collected using a 50-item Stroop Color-Word Test (SCWT), yielding measures of completion time, correct responses, score-time ratio (efficiency), and time interference score (TI). Resting-state fMRI (rs-fMRI) was performed, and neural activity was assessed via amplitude of low-frequency fluctuations (ALFF) to identify regions of interest (ROIs). Multivariable regression models examined associations between education and Stroop outcomes, followed by correlation analyses between ROIs and performance. Bootstrap mediation analysis (5000 resamples) tested whether ROIs mediated the education-Stroop relationship. Results showed that higher education was significantly associated with better Stroop performance-shorter completion time, higher efficiency, and lower TI-after full adjustment (all p < 0.05). Rs-fMRI revealed greater ALFF in the right frontal eye field (FEF), right dorsolateral prefrontal cortex (DLPFC), and left dorsal anterior cingulate cortex (dACC) in the higher education group. These regions correlated negatively with completion time and TI, and positively with efficiency. Mediation analyses confirmed that right FEF, right DLPFC, and the combined ROIs significantly mediated the effects of higher education on Stroop performance. In conclusion, higher education may enhance Stroop performance in non-demented older adults by modulating resting-state neural activity in key cognitive control regions.