TY - JOUR
T1 - Qualitative and quantitative educational disparities and brain signatures in healthy aging and dementia across global settings
AU - Gonzalez-Gomez, Raul
AU - Cruzat, Josephine
AU - Hernández, Hernán
AU - Migeot, Joaquín
AU - Legaz, Agustina
AU - Santamaria-García, Hernando
AU - Fittipaldi, Sol
AU - Maito, Marcelo Adrián
AU - Medel, Vicente
AU - Tagliazucchi, Enzo
AU - Barttfeld, Pablo
AU - Franco-O'Byrne, Daniel
AU - Castro Laguardia, Ana María
AU - Borquez, Patricio A.
AU - Avila-Funes, José Alberto
AU - Behrens, María I.
AU - Custodio, Nilton
AU - Farombi, Temitope
AU - García, Adolfo M.
AU - Garcia-Cordero, Indira
AU - Godoy, Maria E.
AU - Campo, Cecilia Gonzalez
AU - Hu, Kun
AU - Lawlor, Brian
AU - Matallana, Diana L.
AU - Miller, Bruce
AU - Okada de Oliveira, Maira
AU - Pina-Escudero, Stefanie D.
AU - de Paula França Resende, Elisa
AU - Reyes, Pablo
AU - Slachevsky, Andrea
AU - Takada, Leonel T.
AU - Yener, Görsev G.
AU - Coronel-Oliveros, Carlos
AU - Ibañez, Agustin
N1 - Publisher Copyright:
© 2025 The Author(s)
PY - 2025/4
Y1 - 2025/4
N2 - Background: While education is crucial for brain health, evidence mainly relies on individual measures of years of education (YoE), neglecting education quality (EQ). The effect of YoE and EQ on aging and dementia has not been compared. Methods: We conducted a cross-sectional assessment of the effect of EQ and YoE on brain health in 7533 subjects from 20 countries, including healthy controls (HCs), Alzheimer's disease (AD), and frontotemporal lobar degeneration (FTLD). EQ was based on country-level quality indicators provided by the programme for international student assessment (PISA). After applying neuroimage harmonization, we examined its effect, along with YoE, on gray matter volume and functional connectivity. Regression models were adjusted for age, sex, and cognition, controlling for multiple comparisons. The influence of image quality was assessed through sensitivity analysis. Data collection was conducted between June 1 and October 30, 2024. Findings: Less EQ and YoE were associated with brain alterations across groups. However, EQ had a stronger influence, mainly targeting the critical areas of each condition. At the whole-brain level, EQ influenced volume (HCs: Δmean = 2·0 [1·9–2·0] × 10−2, p < 10−5; AD: Δmean = 0·1 [−0·0 to 0·3] × 10−2, p = 0·18; FTLD: Δmean = 3·5 [3·0–4·0] × 10−2, p < 10−5; all with 95% confidence intervals) and networks (HCs: Δmean = 13·5 [13·2–13·7] × 10−2, p < 10−5; AD: Δmean = 5·9 [5·2–6·7] × 10−2, p < 10−5; FTLD: Δmean = 13·2 [11·2–13·7] × 10−2, p < 10−5) 1·3 to 7·0 times more than YoE. These effects remain robust despite variations in income and socioeconomic factors at country and individual levels. Interpretation: The results support the need to incorporate education quality into studying and improving brain health, underscoring the importance of country-level measures. Funding: Multi-partner consortium to expand dementia research in Latin America (ReDLat).
AB - Background: While education is crucial for brain health, evidence mainly relies on individual measures of years of education (YoE), neglecting education quality (EQ). The effect of YoE and EQ on aging and dementia has not been compared. Methods: We conducted a cross-sectional assessment of the effect of EQ and YoE on brain health in 7533 subjects from 20 countries, including healthy controls (HCs), Alzheimer's disease (AD), and frontotemporal lobar degeneration (FTLD). EQ was based on country-level quality indicators provided by the programme for international student assessment (PISA). After applying neuroimage harmonization, we examined its effect, along with YoE, on gray matter volume and functional connectivity. Regression models were adjusted for age, sex, and cognition, controlling for multiple comparisons. The influence of image quality was assessed through sensitivity analysis. Data collection was conducted between June 1 and October 30, 2024. Findings: Less EQ and YoE were associated with brain alterations across groups. However, EQ had a stronger influence, mainly targeting the critical areas of each condition. At the whole-brain level, EQ influenced volume (HCs: Δmean = 2·0 [1·9–2·0] × 10−2, p < 10−5; AD: Δmean = 0·1 [−0·0 to 0·3] × 10−2, p = 0·18; FTLD: Δmean = 3·5 [3·0–4·0] × 10−2, p < 10−5; all with 95% confidence intervals) and networks (HCs: Δmean = 13·5 [13·2–13·7] × 10−2, p < 10−5; AD: Δmean = 5·9 [5·2–6·7] × 10−2, p < 10−5; FTLD: Δmean = 13·2 [11·2–13·7] × 10−2, p < 10−5) 1·3 to 7·0 times more than YoE. These effects remain robust despite variations in income and socioeconomic factors at country and individual levels. Interpretation: The results support the need to incorporate education quality into studying and improving brain health, underscoring the importance of country-level measures. Funding: Multi-partner consortium to expand dementia research in Latin America (ReDLat).
KW - Aging and dementia
KW - Brain health
KW - Education quality
KW - Educational disparities
KW - Years of education
UR - http://www.scopus.com/inward/record.url?scp=105002308970&partnerID=8YFLogxK
U2 - 10.1016/j.eclinm.2025.103187
DO - 10.1016/j.eclinm.2025.103187
M3 - Article
AN - SCOPUS:105002308970
SN - 2589-5370
VL - 82
JO - eClinicalMedicine
JF - eClinicalMedicine
M1 - 103187
ER -
