Public Health

Area of Science:

• Neuroscience
• Public Health
• Genetics

Background:

• Educational attainment (EA) is a crucial factor for cognitive reserve, enhancing brain resilience against Alzheimer's disease pathology (ADP).
• The impact of EA on cognitive reserve may differ across racial/ethnic groups and APOE genotypes, necessitating diverse population studies.
• This study investigates EA, APOE ε4 status, and cognitive function in Puerto Rican (PR) adults with elevated plasma pTau181, a marker of ADP.

Purpose of the Study:

• To examine the relationship between educational attainment (EA) and cognitive function in Puerto Rican older adults with elevated Alzheimer's disease pathology (ADP).
• To investigate how APOE ε4 genotype modifies the association between EA and cognitive function in the presence of ADP.

Main Methods:

• Analyzed data from 793 Puerto Rican older adults with elevated plasma pTau181.
• Cognitive function assessed using the Clinical Dementia Rating scale functional composite (CDR-FUNC).
• EA was dichotomized (high >9 years, low ≤9 years); associations with CDR-FUNC and APOE ε4 status were tested using Mann-Whitney U tests.

Main Results:

• Lower EA was significantly associated with worse cognitive function in individuals with elevated pTau181 (p=6.5×10⁻⁴).
• The association between EA and cognitive function was stronger in APOE ε4 carriers (p=1.52×10⁻³) than non-carriers (p=0.06).
• In the low EA group, APOE ε4 carriers showed poorer cognitive function than non-carriers (p=0.045), a difference not seen in the high EA group.

Conclusions:

• Educational attainment (EA) may bolster cognitive reserve and resilience to Alzheimer's disease pathology (ADP) in the Puerto Rican population.
• High EA provides a cognitive advantage against functional decline, even with elevated pTau181.
• APOE ε4 carriers with low EA face a higher risk of cognitive decline compared to those with high EA, emphasizing the interplay of genetics and education.