{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T14:12:16Z","timestamp":1778767936848,"version":"3.51.4"},"posted":{"date-parts":[[2026,5,12]]},"group-title":"Neurology","reference-count":76,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,5,12]]},"abstract":"<jats:title>Structured Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>INTRODUCTION<\/jats:title>\n                  <jats:p>Educational attainment is a key proxy of cognitive reserve (CR), but whether its association with cognition persists after accounting for multimodal brain pathology remains unclear.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>Data from PREVENT-AD and CIMA-Q were analyzed using cross-sectional, longitudinal, and residual-based models adjusted for multimodal pathology, including MRI-based white matter hyperintensities and atrophy measures, and plasma Alzheimer\u2019s disease biomarkers. Education was examined in both cohorts. A multidimensional CR questionnaire was also examined in CIMA-Q.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Higher education was associated with better performance across multiple cognitive domains after accounting for pathology (p &lt; 0.05). The CR composite score showed less consistent associations, and non-education subdomains showed limited added value. Longitudinally, education was more consistently associated with baseline cognitive levels than cognitive change, with executive-function trajectory differences observed in PREVENT-AD.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>DISCUSSION<\/jats:title>\n                  <jats:p>Findings support a CR framework in which education relates to better cognition despite pathology, while effects on decline are limited and domain-specific.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.05.07.26352659","type":"posted-content","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T14:25:42Z","timestamp":1778595942000},"source":"Crossref","is-referenced-by-count":0,"title":["Education, Cognitive Reserve, and Brain Pathology in Aging and Alzheimer\u2019s Disease: Evidence from Preclinical and Symptomatic 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Montreal, Quebec, H3A 1A1, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0583-5811","authenticated-orcid":false,"given":"Yashar","family":"Zeighami","sequence":"additional","affiliation":[{"name":"Douglas Research Center, Montreal, Quebec, Canada, H4H 1R3, Canada"},{"name":"Department of Psychiatry, McGill University, Montreal, Quebec, H3A 1A1, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"The PREVENT-AD Research Group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"The Consortium for the Early Identification of Alzheimer\u2019s Disease - Quebec (CIMA-Q)","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1087-5770","authenticated-orcid":false,"given":"Cassandra","family":"Morrison","sequence":"additional","affiliation":[{"name":"Department of Psychology, Carleton 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