A Systematic Review of the Measurement and Influence of Quality of Education on Neuropsychological Test Performance in Later Life

Years or highest level of formal education are typically used to quantify educational experience and stratify normative data. However, these approaches do not account for differences in education quality which may lead to misclassification of cognitive abilities. The present systematic review aimed to synthesize existing literature on the measurement of education quality and evaluate its effects on neuropsychological test performance in later life. Databases were searched to identify eligible studies that explored the effects of education quality on neuropsychological test scores in older adult populations (age ≥ 55 years). A narrative synthesis of the included studies was conducted, and the quality of evidence was assessed. The study was pre-registered on PROSPERO (Project ID: CRD42024373157). Of the 2,338 records identified, 16 studies were included in the review. Measurement of education quality was categorized in two ways: as performance-based proxies (typically assessment of literacy and numeracy), or as retrospective indicators of quality based on historical data or self-report. Proxies were most commonly tests of reading ability. Education quality measures correlated highly with years of education but emerged as stronger predictors of cognitive test performance. Findings suggest that education quality may be a more useful measure of educational experience than years of education, particularly for minoritized ethnic groups. This highlights the need to select tests that minimize the effects of education on cognitive test performance and to incorporate education quality measures. Future research should investigate the extent to which these measures represent education quality cross-culturally.