Study: Formal education does not slow brain aging or cognitive decline

An international study published in the journal Nature Medicine casts doubt on the widespread belief that higher levels of formal education directly protect against cognitive decline and brain aging. The study analyzed longitudinal data from more than 170,000 people in 33 western countries, making it one of the largest studies of cognitive aging to date. The University of Barcelona and the Institut Guttmann are the only two centres in Spain to participate in the study, led by the University of Oslo (Norway) as part of the European Lifebrain consortium.

The results reinforce the need for policies and programmes to promote brain health that go beyond cognitive activity and span the entire life course, not just in childhood and youth.

According to previous studies, although the total number of people with dementia worldwide is increasing due to population growth and aging, the incidence appears to be decreasing and older adults have better cognitive function today than they did 20 years ago. This trend is attributed to lifestyle changes in the population, and until now, the most widely held hypothesis held that formal education may provide protection against neurodegeneration or normal brain aging.

However, the team has found that although people with more years of formal education tend to start with a higher cognitive level in adulthood, they do not experience slower cognitive decline with age.

Arguably, having a higher level of education puts you in an advantageous position at the beginning of the race, but once the race starts it does not allow you to go faster and does not indicate any shortcuts: you will face the same obstacles as everyone else, and they will affect you just like everyone else."

Professor David Bartrés-Faz, from the Faculty of Medicine and Health Sciences and the UB Institute of Neurosciences (UBneuro), and principal investigator of the Institut Guttman's Barcelona Brain Health Initiative (BBHI)

Previous studies have had conflicting results and were often limited to small or single-country samples. The now published study has analysed more than 420,000 neuropsychological tests and imaging tests of individuals from multiple countries and cohorts (European, American, Asian and Australian) with different methodologies, making it one of the most robust and generalizable investigations on the subject. In total, 170,795 people aged over 50 participated, belonging to 27 longitudinal cohorts and with a follow-up of up to 28 years per participant.

​​​​​Specifically, the BBHI cohort contributed 966 subjects to the study, while UB contributed 161. Participants underwent tests of memory, reasoning, processing speed and language, and 6,472 individuals also underwent brain MRI scans to analyse parameters such as total brain volume and the volume of key memory regions (hippocampus and prefrontal cortex).

A very similar evolution

According to the results, a higher level of education is associated with better memory, larger intracranial volume and a slightly larger volume of memory-sensitive brain regions. "One plausible explanation is that it is the initial neurobiological traits of individuals that favour higher educational attainment, and not the other way around", notes researcher Gabriele Cattaneo (BBHI). And all groups, regardless of their level of education, showed a cognitive decline and structural brain aging almost in parallel over time.

"This does not detract from the fact that starting from a better cognitive reserve provides an advantage, because if you start higher, you will end up higher. Clearly, education and early schooling improve cognitive function throughout life, but they do not influence the rate of decline or the structural aging of the brain. Regardless of the education level, all brains change in very similar ways in midlife and old age", Cattaneo continues.

The paper raises important questions for public policy on brain health and healthy aging. "While promoting education remains essential, the results indicate that it is not sufficient for healthy aging. That is, it is not enough to accumulate years of schooling to protect the brain from aging. A broader, multifactorial approach is needed that includes lifelong interventions such as physical activity, ongoing cognitive stimulation, social relationships and prevention of vascular risk factors", concludes Javier Solana, research director at Institut Guttmann.