Education does not protect cognitive function from brain pathology in the ADNI 2 cohort

Educational attainment is widely accepted as a cognitive reserve variable. However, few studies have demonstrated that education statistically moderates the effects of pathology on cognition. Here, we explored this issue in a sample of 441 Alzheimer's disease (AD) and mild cognitive impairment participants from the Alzheimer's Disease Neuroimaging Initiative cohort who had AD markers (Aβ₄₂, tau, structural brain volumes) at baseline and underwent cognitive testing at baseline and at 6-month, 12-month, and 24-month time points. An AD-related biomarker (atrophy/pathology) composite at baseline was developed using stepwise backward linear regression. Potential moderation effects of education on the relationship between AD biomarkers and cognition were explored using linear mixed models. Education was positively correlated with cognition, and biomarkers were negatively correlated with cognition, across domains and diagnostic groups. However, education generally did not moderate the effects of biomarkers on baseline or longitudinal cognition. Our results do not support the hypothesis that education protects cognitive function from brain pathology in the Alzheimer's Disease Neuroimaging Initiative cohort, questioning its accepted status as a reserve variable.