Education Lowers Dementia Risk During Essential Tremor

Education protects against dementia

Dementia is a progressive decline in mental function, characterized by increasing memory loss, personality changes, and inability to reason things through. The term itself is something of a catch-all, since there are different types of dementia. Some are linked with certain degenerative neurologic diseases like Alzheimer’s disease or Parkinson’s disease. Another type can develop after a stroke or other brain damage. If there is no co-existing disease, dementia can simply be part of aging.

A large and consistent body of research supports the idea that education offers a protective benefit against dementia in later years. There are two theories about how it does so:

  1. The more education a person has, the greater likelihood that he/she makes overall healthy lifestyle choices (nutrition, exercise, stress management) that preserve physical and mental well-being
  2. Education helps build a “cognitive reserve” in the brain that fosters continued cognitive functions even if a condition or disease of the brain develops (for example, another part of the brain can step in and compensate for failure of another area)

Evidence that education is effective

A group of German researchers studied nearly 1,700 individuals age 75+ whose mental function was followed and assessed five times at 1 ½ year intervals, with a final assessment at 15 years. They found that at least 10 years of education was a threshold for reduced risk of dementia, and that “every additional year of education significantly decreased the risk to develop dementia.”1 Why might this be?

A possible explanation could be that at the age when we typically go to school, the brain is in a major developmental phase and therefore more school years could influence the development of the brain over a longer period.2

If so, this supports the hypothesis that the brain continues to add to its cognitive reserve, similar to a person who makes deposits into a long-term savings account.

Education and essential tremor

Controversy exists as to whether essential tremor (ET) increases the risk of dementia. There is published evidence on both sides of the issue. However, if it eventually proves to be the case that older people with ET are more prone to progressive cognitive function, it would be worthwhile to ask if more years of education would confer a protective benefit.

A paper by a multi-institution research team explored that question. Benito-León, et al. (2016) accept research that “individuals with late-onset ET (e.g., older adults) seem to have an increased prevalence of mild cognitive impairment and dementia, and a higher risk of incident dementia than those with earlier-onset ET.”3 They note that there may be a pre-tremor stage of ET in which nonmotor symptoms (e.g. depressive symptoms or faster cognitive decline) appear. By the time tremors begin, there is more pronounced physical dysfunction or deterioration in the brain. Therefore, they hypothesize that patients identified during the premotor phase of ET, who also had post-high school education or training, would have lower risk of developing dementia than less educated patients.

After collecting and analyzing their data, the authors report that education beyond high school offers protection from dementia in the premotor phase of ET, but not during the motor phase. They theorize that this may be due to using up the cognitive reserve that was built up. While the brain is using it, dementia is less likely to show up because the brain’s reserves are acting as substitutes for the more deteriorated areas of the brain. In other words, activating the cognitive reserves “masks” degenerating cognitive function. Once the reserves are depleted, dementia appears rather quickly.

Unanswered questions

No one fully understands how education, particularly after high school, physically changes the brain’s biology in such a way that the risk of dementia is lowered, as observed in the general population, as observed in the German study mentioned earlier. It is also unclear whether such education plays a part in slowing mental deterioration during Alzheimer’s, or if a cognitive reserve is simply helping these patients manage more effectively until the reserve is depleted. Other unanswered questions have to do with the content of the education a person receives from childhood until they complete school and enter the workforce. After all, education is not simply acquiring knowledge, but also learning problem solving skills, social skills, developing critical thinking, etc. Do some build reserve more than others?

One thing is certain: education doesn’t end when we receive our diplomas. It’s good to continue to follow our curiosity, learn new things, do brain teasers, etc. Investing in the brain’s ongoing development has been shown time and again to improve general quality of life as we get older.

Treating ET with Focused Ultrasound

Currently, the Sperling Neurosurgery Associates offers FDA-approved Neuravive, a treatment for essential tremor (ET) using MRI-guided Focused Ultrasound, or MRgFUS. ET patients whose tremors do not respond to medication, or who do not wish to use medication, are invited to arrange a consultation. For more information, visit our website.


1 Then, Francisca S. “Years of education may protect against dementia.” OUP Blog, Aug. 19, 2016. https://blog.oup.com/2016/08/years-of-education-dementia/
2Ibid.
3Julián Benito-León, J, Contador I, Louis E, Cosentino S, Bermejo-Pareja F. Education and risk of incident dementia during the premotor and motor phases of essential tremor (NEDICES). Medicine (Baltimore). 2016 Aug; 95(33): e4607.

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