An association between higher education and better brain health can still be seen in people over 90, according to recent findings by a Finnish team, who said that in contrast, midlife risk factors for cardiovascular disease were not found to be linked to memory function at this advanced age.
The study, published in PLOS One, highlights the importance of education in preventing memory disorders and provide new information on why some people maintain good cognitive function despite their advanced age, said the scientists.
Earlier research has shown that cardiovascular risk factors like high blood pressure, high cholesterol, lack of exercise and elevated body mass index, increase the risk of dementia.
This study investigated how risk and protective factors measured decades ago predict cognitive function in over-90s.
Schooling still matters after 90
“This is an important topic, as there has been very little research on cognitive ageing in people in their 90s, even though this age group is set to grow in the future. In addition, the likelihood of memory disorders is highest in late old age,” according to FIMM team leader Eero Vuoksimaa, (Institute for Molecular Medicine Finland [FIMM], HiLIFE, University of Helsinki), who led the study.
The research is based on a unique long-term twin study launched in 1975, in which participants’ health has been monitored for nearly 50 years.
The results showed a clear link between education and memory performance in 90-year-olds. Participants who had attended school for 12 years or more performed better on cognitive tests than those with fewer than seven years of education. Even those with seven-11 years of schooling outperformed the least-educated group.
“The protective effect of higher education, even at the age of 90, may be related to the brain’s ability to compensate for the effects of ageing, a capacity strengthened by education,” said Anni Varjonen, a Doctoral Researcher at the University of Helsinki and lead author of the study.
No evidence of midlife heart risk factors affecting memory
No connection was found between cardiovascular risk factors and memory function in this age group. This may reflect that people who reach the age of 90 often differ from the general population, for example, in terms of lifestyle or overall health.
“It is possible that people who have lived to 90 are less susceptible to the effects of dementia risk factors. However, longitudinal studies with larger datasets are needed to confirm this,” Varjonen said.
Cognitive function in the study was assessed via telephone interviews with 96 participants in the NONAGINTA-Memory and Health in Nonagenarians twin study.
According to Vuoksimaa, the study also offered valuable practical insights into conducting telephone-based memory tests with this age group.
“It was great to see how many participants from the original twin study were still willing to take part,” he added.
Study details
Midlife and old-age cardiovascular risk factors, educational attainment, and cognition at 90-years – population-based study with 48-years of follow-up.
Anni Varjonen et al.
Published in PLOS One on 1 October 2025.
Abstract
We examined the associations of midlife and old-age cardiovascular risk factors, education, and midlife dementia risk scores with cognition at 90 + years, using data from a population-based study with 48 years of follow-up. Participants were 96 individuals aged 90–97 from the older Finnish Twin Cohort study. Individual cardiovascular risk factors assessed via questionnaires in 1975, 1981, 1990, and 2021–2023 included blood pressure, body mass index, physical activity, and cholesterol, and self-reported educational attainment. The Cardiovascular Risk Factors, Ageing, and Dementia (CAIDE) score and an educational-occupational attainment score were used as midlife dementia risk scores. Cognitive assessments included semantic fluency, immediate and delayed recall from a 10-word list learning task, and a composite cognitive score. Regression analyses were conducted with dementia risk factors predicting cognition at 90 + years, adjusting for age, sex, education, follow-up time, and apolipoprotein E genotype (ε4-carrier vs non-carriers). Results showed that higher education and higher educational-occupational score were associated with better cognitive performance in all cognitive measures. Those with high midlife blood pressure scored significantly higher in all cognitive tests than those with normal blood pressure. Conversely, those with high old-age blood pressure scored lower in semantic fluency and composite cognitive score, but not in immediate or delayed recall. Other cardiovascular risk factors and the CAIDE score did not show consistent associations with cognition. Education appears to have a long-lasting protective effect in cognitive ageing, whereas midlife and old-age cardiovascular risk factors were not significantly associated with cognition at 90 + years.
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