Association between educational attainment and amyloid deposition across the spectrum from normal cognition to dementia: A meta-analysis.

Background & Aim: Educational attainment has been proposed as a critical factor influencing cognitive resilience in the face of neurodegenerative diseases. However, its relationship with amyloid deposition across different stages of cognitive decline remains unclear. This systematic review and meta-analysis aimed to investigate the correlation between educational background and amyloid accumulation in individuals ranging from cognitively normal to those diagnosed with Alzheimer's disease (AD) or mild cognitive impairment (MCI). Methods: A comprehensive literature search was conducted in January 2025 across PubMed, Scopus, and Google Scholar to identify observational studies examining the association between educational attainment and amyloid deposition. Studies were included if they reported relevant data on this relationship; reviews, interventional studies, and those with insufficient outcome reporting were excluded. Data were analyzed using RStudio (version 4.3.1), employing random-effects or fixed-effects models based on the degree of heterogeneity. Effect sizes were expressed as Pearson's correlation coefficients (r). Results: Out of 6988 initially identified records, four cohort studies met the inclusion criteria, comprising a total of 288 participants from Canada and Japan. Meta-analysis revealed a significant positive correlation between educational attainment and amyloid deposition among individuals with MCI (r = 0.34, 95 % CI [0.05, 0.63]), although substantial heterogeneity was observed (I² = 86 %, p < 0.01). In contrast, an inverse association was found in patients with AD (r = -0.16, 95 % CI [-0.28, -0.03]), with minimal heterogeneity (I² = 0.0 %, p = 0.8101). Funnel plot analyses indicated no significant evidence of publication bias. Conclusion: These findings suggest a stage-dependent relationship between educational attainment and amyloid accumulation: higher education is associated with greater amyloid deposition in individuals with MCI, but with reduced amyloid burden in those with AD. This pattern supports the cognitive reserve hypothesis, which posits that education may bolster compensatory neural mechanisms, delaying the clinical onset of dementia symptoms. However, the presence of substantial heterogeneity and the limited sample size call for further longitudinal research to elucidate underlying causal pathways and inform targeted strategies for dementia prevention.