{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T11:10:13Z","timestamp":1778670613509,"version":"3.51.4"},"reference-count":49,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T00:00:00Z","timestamp":1770595200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T00:00:00Z","timestamp":1770595200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["AG070864"],"award-info":[{"award-number":["AG070864"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["AG074865"],"award-info":[{"award-number":["AG074865"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012513","name":"Coins for Alzheimer's Research Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012513","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Alzheimer\u2019s Disease"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Education promotes cognitive reserve (CR), potentially buffering Alzheimer's disease pathology (ADP). However, the education-CR relationship may differ by population and genetic background.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      To examine education,\n                      <jats:italic toggle=\"yes\">APOE<\/jats:italic>\n                      \u03b54, and functional scores in a Puerto Rican (PR) cohort with varying plasma pTau181, an ADP biomarker.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A subset of 514 PR older adults with \u201chigh\u201d (&gt;mean+1SD) or \u201clow\u201d pTau181 (&lt;mean-1SD) was analyzed. Functional scores were derived from the Clinical Dementia Rating scale (CDR-FUNC). The primary analysis examined educational attainment (EA; high \u226512 years versus low &lt;12 years) as a categorical proxy for CR. Nonparametric tests compared CDR-FUNC across EA and\n                      <jats:italic toggle=\"yes\">APOE<\/jats:italic>\n                      \u03b54 strata. A secondary analysis applied a hurdle model, examining years of education as a continuous predictor on (1) the odds of any impairment (CDR-FUNC &gt; 0) and (2) severity among impaired participants, adjusting for age and sex.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      High EA was associated with better CDR-FUNC than low EA within the high pTau181 group (n\u2009=\u200980; Median\n                      <jats:sub>Low_EA<\/jats:sub>\n                      \u2009=\u20097, Median\n                      <jats:sub>High_EA<\/jats:sub>\n                      \u2009=\u20090; p\u2009=\u20090.011). The hurdle model similarly showed that each additional year of education reduced the odds of any functional impairment in the high-pTau181 group (OR\u2009=\u20090.89, 95% CI [0.79\u20130.99]). No significant education \u00d7\n                      <jats:italic toggle=\"yes\">APOE<\/jats:italic>\n                      \u03b54 interaction was observed, though a negative trend suggested that increasing education attenuated \u03b54-related impairment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Greater education is linked to functional preservation in PR older adults, particularly in those with elevated ADP, suggesting potential CR-mediated resilience.\n                      <jats:italic toggle=\"yes\">APOE<\/jats:italic>\n                      \u03b54 may worsen outcomes with decreasing education, suggesting both educational and genetic factors should inform strategies to mitigate cognitive decline globally.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13872877261415933","type":"journal-article","created":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T13:26:09Z","timestamp":1770643569000},"page":"685-695","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Educational attainment is associated with reduced functional decline in Puerto Ricans with elevated pTau181"],"prefix":"10.1177","volume":"110","author":[{"given":"Daniel A.","family":"Dorfsman","sequence":"first","affiliation":[{"name":"John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA"},{"name":"Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dingtian","family":"Cai","sequence":"additional","affiliation":[{"name":"John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kara L.","family":"Hamilton-Nelson","sequence":"additional","affiliation":[{"name":"John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Larry D.","family":"Adams","sequence":"additional","affiliation":[{"name":"John P. 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