Education and Dementia
Education and Dementia
ABSTRACT & COMMENTARY
Source: De Ronchi D, et al. The effect of education on dementia occurrence in an Italian population with middle to high socioeconomic status. Neurology 1998;50:1231-1238.
Neurologists, through their knowledge of brain function in health and disease, have a special understanding of the influence that brain training applies to an adult's achievements. As such, they can well understand the productive contribution of early education as well as a stimulating immediate environment on the infant's and young child's brain. De Ronchi and colleagues cite previous sources that indicate a two- to three-fold increase in late-life dementia among persons receiving no early life education compared to those receiving even a low level of formal school work. This report analyzes the eventual life outcome among a group of Italian rural villagers born prior to 1931. Participants included 214 men and 281 women. Mean years of education were 3.7 (range, 0-18). Fifty-six subjects were diagnosed as demented. Of them, 52% had Alzheimer's disease (AD), 25% had vascular dementia (VaD), 16% had mixed disease (MD), and 7.1% had secondary dementia. Economically, being rural at the time, the population was not nutritionally and socially deprived. Characterizing all patients for occupation, years of education, and gender, only education stands out as a major single factor concordant with late life dementia. Among the 13% of the population who went unschooled, the odds risk of dementia past age 60 years was 4.7 times greater than those with at least three years of education. Furthermore, AD and VaD (rather than alcoholic, trauma, smoking, etc.) accounted for the heavy bias affecting the uneducation cohort.
COMMENTARY
In their discussion, De Ronchi and colleagues emphasize the earlier speculation made by R. Katzman (Neurol 1993;43:13-20) that infantile education may engender increased permanent contacts within the cortical-thalamic neuropil. Certainly, much recent evidence shows that cortical circuitry can undergo plasticity in response to appropriate somatic activity and that kind of adaptation can be induced well beyond adulthood (e.g., Pons TP. Nature Med 1998;4:561-562). The inference in De Ronchi et al's indirect study, however, implies that lack of infantile and early school age intellectual stimulation can seriously and permanently deprive the human brain of its capacity for learning. Presumably such a process can require only moderate future degeneration to result in functional dementia. If so, this is a social disaster.
Neurologists, more than any other group of physicians, recognize that the ultimate purpose of all medicine and education is to protect and preserve the thinking brain's immediate capacity for building personality, intelligence, and understandings. De Ronchi's findings (and many others') provide strong evidence that if we deprive young children of the chance to learn, we not only reduce their future ability to support themselves (and their families), we also increase their probability of late-life dementia and dependency.
Alert urges its readers to promulgate these important principles among their friends, especially among those interested in preschool and early school teaching and learning. Without such efforts, it seems unavoidable that absent preschool education, inane daytime television, and the often chaotic atmosphere that can dominate kindergartens and grammar school all increase a child's later risk of premature dementia. If De Ronchi et al's retrospective analysis is correct, a lack of early education increases risk of late-life dementia by almost five times. Who's going to pay for the burden of disability, which far exceeds early educational costs? The well achieved, of course. But just think of how many fewer taxes those well-educated survivors might have incurred had their parents demanded that all children require early teaching-learning, thereby reducing numbers of future social dependents. Neurologists, please speak your knowledge. -fp
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