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Educational attainment is associated with reduced functional decline in Puerto Ricans with elevated pTau181.

Daniel A Dorfsman^1,2, Dingtian Cai¹, Kara L Hamilton-Nelson¹

¹John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA.

Journal of Alzheimer'S Disease : JAD

|February 9, 2026

Summary

Higher education enhances cognitive reserve (CR), protecting against Alzheimer's disease pathology (ADP) in Puerto Rican adults. This suggests education and genetics are key to mitigating cognitive decline.

Keywords:

APOE Alzheimer's disease cognitive reserve education plasma biomarkers

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Area of Science:

Neuroscience
Cognitive Aging
Public Health

Background:

Education is thought to build cognitive reserve (CR), offering protection against Alzheimer's disease pathology (ADP).
The relationship between education and CR may vary across different populations and genetic backgrounds.
This study investigates these factors in a Puerto Rican cohort.

Purpose of the Study:

To examine the interplay of educational attainment (EA), APOE ε4 genotype, and functional status in Puerto Rican older adults.
To assess these relationships in the context of varying plasma pTau181 levels, a biomarker for ADP.

Main Methods:

Analysis of 514 Puerto Rican older adults, stratified by high (>mean+1SD) or low (
Functional scores were assessed using the Clinical Dementia Rating scale (CDR-FUNC).
Educational attainment was categorized (high ≥12 years vs. low <12 years), and a hurdle model analyzed years of education continuously.

Main Results:

High EA correlated with better functional scores (CDR-FUNC) compared to low EA in individuals with high pTau181 levels (p=0.011).
Each additional year of education reduced the odds of any functional impairment in the high pTau181 group (OR=0.89, 95% CI [0.79-0.99]).
No significant interaction between education and APOE ε4 was found, but a trend suggested education may buffer APOE ε4-related impairment.

Conclusions:

Increased educational attainment is associated with preserved function in Puerto Rican older adults, particularly those with elevated Alzheimer's disease pathology.
This suggests a CR-mediated resilience effect.
Both educational and genetic factors (APOE ε4) appear crucial for developing strategies to mitigate cognitive decline globally.