Relation of education to brain size in normal aging: Implications for the reserve hypothesis

Objective: To examine the relations between education and age-related changes in brain structure in a nonclinical sample of elderly adults. Background: Education may protect against cognitive decline in late life - an observation that has led to the 'reserve' hypothesis of brain aging. Little is known, however, about the effect of education on age-related changes in brain structure. Methods: Quantitative MRI of the brain was performed in 320 elderly volunteers (age range, 66 to 90 years) living independently in the community (Mini-Mental State Examination scores ≥ 24), all of whom were participants in the Cardiovascular Health Study. Blinded measurements of global and regional brain size were made from T1-weighted axial images using computer-assisted edge detection and trace methodology. High measurement reliabilities were obtained. Results: Regression analyses (adjusting for the effects of intracranial size, sex, age, age-by-sex interactions, and potential confounders) revealed significant main effects of education on peripheral (sulcal) CSF volume - a marker of cortical atrophy. Each year of education was associated with an increase in peripheral CSF volume of 1.77 mL (p < 0.03). As reported previously, main effects of age (but not education) were observed for all of the remaining brain regions examined, including cerebral hemisphere volume, frontal region area, temporoparietal region area, parieto-occipital region area, lateral (Sylvian) fissure volume, lateral ventricular volume, and third ventricle volume. Conclusions: The authors' findings demonstrate a relation between education and age-related cortical atrophy in a nonclinical sample of elderly persons, and are consistent with the reserve hypothesis as well as with a small number of brain imaging studies in patients with dementia. The neurobiological basis and functional correlates of this education effect require additional investigation.