To the Editor.
—Dr Stern and colleagues1 propose that "[a]dvanced educational and occupational attainment may also supply a reserve that allows an individual to cope longer before AD [Alzheimer's disease] is clinically expressed." A more parsimonious hypothesis would be that those of lower socioeconomic status are exposed to more environmental insult in life such as pollutants2 and malnutrition that may cause a global neurological insult that allows the pathological lesion of AD to become clinically manifest at an earlier stage.
Devitt N, Fe S. Education, Occupation, and Alzheimer's Disease. JAMA. 1994;272(18):1405. doi:10.1001/jama.1994.03520180029015