The “SuperAgers” construct in clinical practice: neuropsychological assessment of illiterate and educated elderly

Abstract

Introduction:The demographic transition is a global event intensified during the last decades that represents population aging. Thus, the studies directed to the elderly 80 years of age or more with preserved cognitive functions (named SuperAgers) emerges as a possible path to full comprehension of the health of those aging with acceptable levels of functionality and independency.Objective:To evaluate the cognitive performance of the elderly over 80 years old, associating the results to their educational level.Method:We evaluated 144 healthy elders with 80 years or more through the following cognitive tests Mini-Mental State Examination (MMSE), Cambridge Cognitive Examination (CAMCOG), Clock Drawing Test (CDT), and Verbal Fluency Test (VF) and compared the tests’ scores with their educational level segmented in years of formal education, being the groups ILLITR (<1 year of schooling), 1TO4 (from 1 to 4 years of schooling), and 5MORE (>5 years of schooling).Results:There was positive influence of educational level on the cognitive tests’ score, which indicates higher cognitive reserve of the elderly with higher educational levels.Conclusion:The functionality and independence of the so-called SuperAgers is determined by the cognitive reserve acquired throughout life, mainly developed by the years of formal education.

SuperAgers in low-education setting: how to assess cognition

“…From this study on, other findings were further described, such as the preservation of the default mode and the salience network in those individuals (Sun et al, 2016). With their results, Balduino et al (2019) present further points to deepen the definition of SuperAgers, since the educational level seems to be directly linked to an excelled performance in older elderly.…”

“…It is possible that some of these skills receive many benefits from formal education. Therefore, in the commented study (Balduino et al, 2019), there was no significant difference in performance in verbal fluency between the elderly >80 illiterate and those who had studied, suggesting that this is due to crystallized intelligence.…”

“…The study of Balduino et al (2019) reveals differences in cognitive performance of elderly aged 80 years and older without dementia, comparing different levels of education. Older people with higher levels of education are better at cognitive tests, indicating higher cognitive reserves.…”

“…Thus, one can question whether such changes occur in the same way in older people with lower cognitive reserve. This is a crucial point about the relevance of the work of Balduino et al (2019), since the sample consisted mostly of individuals with a maximum of 4 years of schooling. In Brazil, current life expectancy is 76 years (IBGE, 2018) and the illiteracy rate in the elderly population is high (19%) (IBGE, 2013).…”

“…As mentioned in the paper, a limitation of the study by Balduino et al (2019) is the fact that a robust cognitive instrument such as Wechsler Intelligence Scales has not been applied. In fact, studies with long and sophisticated neuropsychological batteries may help shed light on the effects of formal education on cognition.…”