Interaction Effect of Awareness and Educational Attainment on the Benefits of Multicomponent Intervention for Persons with Mild Alzheimer's Disease

OBJECTIVE: The study investigated the effect of education on cognitive outcome following a multicomponent intervention program (MIP) for people with Alzheimer's disease (AD), also exploring the additional effect of level of awareness. METHODS: Fifty-five participants with mild AD were randomized to an MIP (intervention group; IG) or a waiting-list (WL) group. They were further stratified into 4 groups by educational attainment (high vs. low) and level of awareness (aware [IGU-] vs. unaware [IGU+]). MIP efficacy in the different groups was measured using the mean change scores (MCSs) in the Cognitive subscale of Alzheimer's disease Assessment Scale, with pre- and post-treatment testing. RESULTS: A negative correlation was found between educational level and the MCS in the IG, whereas the correlation in the WL group was positive. Moreover, an interaction effect emerged between education and awareness. Here, in the group of aware individuals, those with high education benefited more from the intervention than those with low education. This difference was not observed in the unawareness group. CONCLUSION: Higher education may diminish the progression of cognitive decline after MIP, but this potentially depends on the level of awareness.