Alzheimer's patients with a larger brain volume and/or a higher level of education experience less serious consequences of their brain damage. These patients have more 'cognitive reserve', the extent to which the thinking ability is protected against the consequences of brain damage. Later, in the dementia phase of the disease, they deteriorate more quickly. Ultimately, Alzheimer's patients with more cognitive reserve live longer and with more healthy years.

Alzheimer's disease comes in different forms. For example, there is a great variety in the course of the disease. Some people remain stable for a relatively long time, while others deteriorate rapidly. Anita van Loenhoud and Rik Ossenkoppele of the Alzheimer Center Amsterdam of Amsterdam UMC looked at the differences in the course between the time of diagnosis and death. They think these differences have to do with 'cognitive reserve', a brain mechanism that protects the thinking ability from the effects of brain damage. For example, patients with a large cognitive reserve, despite the fact that they have lost many brain cells due to Alzheimer's, still have a relatively good memory.

Portrait of Rik Ossenkoppele and Anita van Loenhoud of Alzheimercenter Amsterdam

Rik Ossenkoppele and Anita van Loenhoud of Alzheimercenter Amsterdam

More healthy years and fewer years of illness

The researchers found that both a larger brain volume and a higher level of education were associated with more cognitive reserve in patients: their brain damage from Alzheimer's generally resulted in less severe symptoms. Educational level was also related to the rate at which symptoms increased over time: among people in the dementia phase of the disease, the higher educated deteriorated at a faster rate.

Van Loenhoud: “That may sound contradictory. But we know that some people are better able to compensate in the early stages of Alzheimer's, while they deteriorate more quickly at a later stage. As a result, they have more years of health and fewer years of illness.” Overall, the higher educated with Alzheimer's lived longer, despite their faster disease course in the dementia phase.

The knowledge of this research can help make a more accurate prediction for the course of Alzheimer’s disease in patients. Read the publication in Neurology: Association of Education and Intracranial Volume With Cognitive Trajectories and Mortality Rates Across the Alzheimer Disease Continuum.