Does education promote resilience and brain health in those with exceptional longevity? The LifeAfter90 study

INTRODUCTION: Educational attainment is associated with better memory performance and greater hippocampal volume, but it is unknown if it is protective after age 90. METHODS: In 277 participants (mean age 93.1 ± 2.2, 54.5% women), we examined associations among education, hippocampal volume, and episodic memory. We further assessed whether the mediation of hippocampal volume on education and memory was moderated by race/ethnicity. RESULTS: Higher education was associated with better episodic memory performance (b = 0.042, [0.009, 0.074]). The association between education and hippocampal volume was positive in Black participants (b = 0.07, [0.011, 0.132]) but negative in Latinx participants (b = -0.04, [-0.074, -0.003]). In a mediation, higher education was directly associated with better memory performance (b = 0.044, [0.011, 0.077]). In Latinx participants, higher education was associated with lower hippocampal volume, which was associated with worse memory (indirect effect: b = -0.011, [-0.027, -0.001]). DISCUSSION: Education has a protective effect on memory even in the oldest-old. The contribution of education to hippocampal volume is heterogeneous across race/ethnic groups. HIGHLIGHTS: Higher education was associated with better episodic memory performance. Higher education was related to greater hippocampal volume among Black adults. Higher education was related to lower hippocampal volume among Latinx adults. In Latinx adults, hippocampal volume mediated the effect of education on memory.