Dementia prevention beyond educational attainment

Studies show that people with a higher level of education have a lower risk of developing cardiovascular disease, obesity, diabetes and depression, which are all risk factors of dementia. This association may be linked to higher education improving career prospects and socioeconomic status, which in turn correlate with secure finances, healthy lifestyles and improved access to health care.

Additionally, recent studies have suggested that education may directly modify our capacity to resist and recuperate from brain damage. On one hand, brain reserve is a fixed quality of the brain and depends on its size and the number of neurons an individual is endowed with. On the other hand, the brain's flexibility and the efficiency of its networks underpin cognitive reserve, which supports the brain's active ability to counteract damage. In contrast to brain reserve, cognitive reserve can improve with lifelong activities such as education, leisure activities and being socially engaged.

With an ageing population it is vital that we identify preventive measures for those at risk of dementia. The English Longitudinal Study of Ageing (ELSA) cohort is proving a valuable resource for investigating how cognitive reserve (assessed through educational attainment, occupational complexity and leisure activities) affects a person's risk of developing dementia in later life.

In my recent paper published in the British Journal of Psychiatry, we compared participants under the age of 80 with a few years of education to those with 15 years of education and found a 44% reduction in the risk of developing dementia in those with a higher educational attainment. However, we didn't record this association in older participants who may have had less access to education during and immediately after the Second World War. Participants with complex occupations also showed a 28% reduction in dementia risk compared to those with less complex occupations, while those under the age of 85 who were highly engaged in leisure activities showed a 26% reduction of risk compared with others in the same age group.

This evidence suggests that education does contribute to cognitive reserve from a young age to adulthood, and that leisure activities from age 50 onwards contribute to cognitive reserve during adulthood and older age. The findings also support the theory that cognitive reserve can be improved throughout life by engaging in a wide range of activities – from reading and using new technologies, to actively participating in clubs, societies and volunteering programmes.

This offers some hope to individuals who, due to historical, environmental or socioeconomic circumstances, may not have benefited from education or other cognitive reserve-enhancing activities in life. Policies that target those at risk of dementia and direct them to engage in social, cognitive and physically stimulating activities may help reduce their risk of developing dementia.

Commenting on the study, Professor Andrew Steptoe, Director of the English Longitudinal Study of Ageing (ELSA) study, explains: 'The disappointing results of pharmacological treatment trials for dementia highlight the need to redouble efforts at prevention. Although we cannot draw causal conclusions from this analysis, our study suggests that the maintenance of active mental and social life in later years may be beneficial.'

Dr Dorina Cadar, the senior author of the study, adds: 'Individuals with greater cognitive reserve seem to exhibit greater efficiency and capacity, being able to compensate more effectively with age and neuropathologic changes. Building cognitive reserve should be a lifetime pursuit!'