Turns out college degrees might not be as overrated as people are starting to think. A new Finnish study suggests education seems to play a bigger role in shoring up cognitive resilience in one’s 90s. It’s a claim that defies the conventional wisdom that cardiovascular health loomed as the strongest influence.
Appearing in PLOS One, the exhaustive research project tracked nearly a century’s worth of lives – literally. Drawing on the Older Finnish Twin Cohort, the team followed the lives of the participants for up to 48 years. They began in midlife and revisited the individuals again in their 90s.
They simply wanted to find out whether cardiovascular risk factors (such as blood pressure, cholesterol, body weight, or physical activity) in middle or later life can help predict how sharp someone will be in extreme old age.
The answer turned out to be not as simple. In fact, an unexpected factor jumped out of the data and surprised the researchers: education.
A Rare Perspective of Aging Brains
The study is part of the NONAGINTA project, which recruits Finns as they turn 90. From the original twin cohort established in 1974, researchers identified 96 participants who underwent cognitive testing over the phone between 2020 and 2023. Many of the participants also had midlife health data dating back to the 1970s.
Study participants took standard assessments: a semantic fluency test (naming as many animals as possible in a minute), immediate and delayed recall from a 10-word list, and a composite score of both measures. Their medical history included repeated self-reports of blood pressure, cholesterol, physical activity, and body mass index, alongside educational attainment.
Education’s Lasting Shield
The data were clear. People with more schooling decades earlier scored dramatically higher across all measures of cognition at age 90 and beyond.
- Those with at least 12 years of education outperformed peers with six or fewer years – by wide margins. The difference translated to much more than a standard deviation on the composite score.
- Even a moderate educational advantage (between seven and 11 years) boosted recall and fluency.
Researchers also relied on an “educational-occupational score” that captured not just years spent in a classroom, but the complexity of one’s career. That, too, correlated positively with cognition at 90, suggesting that lifelong intellectual engagement builds a resilient “cognitive reserve.”
Blood Pressure and the Paradox of Old Age
When it came to blood pressure – the original metric – a more puzzling story emerged. Surprisingly, participants who reported high blood pressure in their 40s performed better at 90 than those with normal readings. And it wasn’t a negligible difference.
Conversely, those with high blood pressure in their 90s scored lower, particularly on semantic fluency tests. This paradox echoes earlier studies that showed that risk factors – such as hypertension or higher body mass index – can flip roles late in life. Sometimes they reflect survival bias or the effects of long-term treatment, rather than and protective influence.
Hypertension awareness was low in Finland during the 1970s. And only a minority of the country’s citizens received medication. Consequently, the authors caution that midlife high blood pressure might have acted as a proxy for earlier access to medical care, which could explain the unexpected link to sharper cognition later.
Other Risk Factors Lag
Other cardiovascular markers failed to show consistent associations. Cholesterol levels, physical activity, and body mass index – at whatever age – failed to reliably predict cognitive outcomes at 90. Nor did the widely used CAIDE score, which scientists originally developed to forecast 20-year dementia risk.
In fact, very old adults who were more physically active showed slightly worse delayed recall, a result the authors argue could reflect reverse causation. Individuals struggling with memory could’ve received encouragement to stay active, or measurement quirks in the oldest could be at play.
Nevertheless, the findings align with established research. Education consistently appears in global dementia reports as one of the strongest protective factors, rivaling lifestyle and medical interventions. Cardiovascular health still matters. But its influence might taper off – or even invert – once individuals hit a certain age.
Why Education Matters
The world’s population of 90-year-olds remains the fastest-growing age group. And nearly 40% of them live with dementia, and it stresses families and health systems alike. Identifying modifiable factors that help preserve cognition is increasingly critical.
The Finnish team concludes that while cardiovascular risk management remains crucial earlier in life, education provides lasting protection.
“Our results suggest that cardiovascular risk factors are at most modestly important by the time people reach their 90s,” the authors write, “but education continues to play a key role.”
Future studies, they add, should combine large population datasets to untangle how early-life intelligence, education, and socio-economic conditions interact with lifelong health to shape cognitive aging.
Staying sharp at 90 might depend more on the algebra you never thought you’d use than your blood pressure. But for younger generations, keeping an eye on both – textbooks and cholesterol – remains a pretty safe bet.
Further Reading
Younger Adults Driving Sharp Rise in Cognitive Disability
Understanding the Characteristics and Burden of Cognitive Impairments in Schizophrenia in the US
