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Most affectedpatients are, in fact, asymptomatic, even at the point atwhich significant vision loss has already occurred.

Another limita-tion of brain reserve theory is that it does not explain thecounterintuitive finding that once Alzheimer’s is diag-nosed, higher IQ and more education are associated withfaster deterioration and more rapid death (Stern et al.,1994; Stern et al., 1995; Teri et al., 1995; Stern et al., 1999;Scarmeas et al., 2006; Hall et al., 2007; Helzner et al., 2007).By contrast, cognitive reserve refers to the ability tomake flexible and efficient use of available brain reservewhen performing tasks (Stern, 2002).

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