APPLIED NEUROPSYCHOLOGY: ADULT

2020, VOL. 27, NO. 6, 525–531

https://doi.org/10.1080/23279095.2019.1575219

WAIS Information Subtest as an indicator of crystallized cognitive abilities

and brain reserve among highly educated older adults: A three-year
longitudinal study
Odelia Elkanaa, Shani Soffera, Osnat Reichman Eisikovitsa, Noga Orenb,c,d, Vered Bezalelb, and
Elissa L. Ashb,d
a
Behavioral Sciences, Academic College of Tel Aviv-Yaffo, Yaffo, Israel; bDepartment of Neurology, Sourasky Medical Center, Tel Aviv,
Israel; cFunctional Brain Center, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; dSackler
Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel

ABSTRACT KEYWORDS
The Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) Information Subtest (IS) is Brain reserve; cognitive
known as a neuropsychological “Hold” test that is relatively resistant to decline with aging. decline; cognitive reserve;
We administered neuropsychological tests among highly educated healthy older adults elderly; high education;
information subtest; MRI;
once a year for three subsequent years. Results showed highly stable performances on the neuropsychological testing
IS across years (Mean Z score: T0 ¼ 1.39, SD ¼ 0.60; T1 ¼ 1.37, SD ¼ 0.77; T2 ¼ 1.50, SD ¼ 0.66;
T3 ¼ 1.48, SD ¼ 0.66), that were significantly higher than zero (T0: t ¼ 12.08; T1: t ¼ 9.29; T2:
t ¼ 11.71; T3: t ¼ 11.68; for all, p < 0.0001). In contrast, other neuropsychological tests
showed differences in performance across time; some performances significantly declined
(Rey Osterrieth Complex Figure test-copy, Rey-Auditory Verbal Learning Test, and Montreal
Cognitive Assessment test [MoCA]), whereas others were improved, possibly due to practice
effects (Rey Osterrieth Complex Figure test- delayed, Rey-Auditory Verbal Learning Test-
delayed, and Trail Making Test- part A). Correlation with whole brain volumetric analysis
revealed a positive correlation between gray matter volumes and IS scores (r ¼ 0.46,
p < 0.05) even when controlling for age and education (partial correlations: r ¼ 0.43; r ¼ 0.45,
for both p < 0.05). No significant correlations were found between gray matter and other
test scores. Therefore, the WAIS-III Information subtest appears to be an adequate neuro-
psychological measurement of crystallized ability in highly educated older adults and may
be considered as a proxy measure of brain reserve.

Introduction
The need for accurate and effective estimation of cog-
nitive ability has become increasingly apparent, espe-
cially when testing for possible mental deterioration in
older individuals. Neuropsychological measures have
historically been used to assess cognitive decline as
well as to estimate premorbid abilities (Apolinario
et al., 2013). The assessment of cognitive decline is
made by comparison to premorbid ability as well as
to normative data with similar demographics, particu-
larly age, due to the expected decline associated with
age (Elkana et al., 2016).
Since most patients do not have documented records
of previous functioning, estimates of premorbid abilities
constitute a critical aspect of neuropsychological assess-
ment. The common neuropsychological techniques
for estimating premorbid ability usually relies on
crystalized (“Hold”) cognitive measures, extrapolation
from current abilities, demographic variables, or some
combination of these (Lezak, Howieson, Loring, &
Fischer, 2012). Verbal skills are considered to be best
preserved and relatively unaffected, long after recent
memory, reasoning, arithmetic ability, and other func-
tions are severely compromised (Ryan, Sattler, &
Lopez, 2000). Therefore, it is assumed that cognitive
skills based on semantic knowledge acquired before
neurological damage are less affected and remain gen-
erally preserved. The discrepancy between performance
on “Hold” tests and performance on other neurocogni-
tive tests helps to assess and quantify the extent of cog-
nitive decline for a specific individual.
The Information Subtest (IS) of the Wechsler Adult
Intelligence Scale-Third Edition (WAIS-III) is a widely
used cognitive test for estimating premorbid ability

CONTACT Odelia Elkana odelia.elkana@gmail.com Academic College of Tel Aviv-Yaffo, 14 RabenuYerucham St. P.O. 8401, Yaffo, 68114, Israel.
ß 2019 Taylor & Francis Group, LLC
526 O. ELKANA ET AL.
Table 1. Participants’ characteristics.
Age (years)
Gender
Education (years)
BMI
Physical exercise: number of time on average
Leisure activity: number of times on average
Cognitive activity: number of weekly hours on average
Number of smokers
Country of birth
Year of immigration in average
Native language
All participants were fluent Hebrew speakers
Country of parent’s Birth
Note. BMI ¼ weight (kg)  height2 (m2); SD = Standard Deviation.
level and is usually considered the best indicator of
original intellectual endowment (Ryan et al., 2000).
Unlike other verbal tests, such as the vocabulary subt-
est, that require oral definition and tend to be more
vulnerable to brain damage, the IS can be answered in
a word or two and is thus more resistant to semantic
losses. Moreover, the IS correlates strongly with edu-
cation level, and usually serves as a good indicator of
premorbid ability (Tremont, Hoffman, Scott, &
Adams, 1998).
A valid estimation of premorbid ability becomes
crucial when individuals are located on either end of
the education scale (highly educated and less edu-
cated), where normative data is generally lacking
(Elkana et al., 2016). However, to the best of our
knowledge, no study investigated the sensitivity of the
IS over time in highly educated, healthy adults.
Higher education level is considered to serve as a
proxy for cognitive reserve (CR). Therefore, educated
individuals are considered to have better tolerance for
brain damage due to greater cognitive reserve,
reflected by generally preserved cognitive ability des-
pite reduced brain volume (Arenaza-Urquijo, Wirth,
& Ch
etelat, 2015). Furthermore, higher levels of CR,
as assessed by educational level, have been found to
be associated with higher levels of brain reserve (BR),
such as brain volume (Arenaza-Urquijo et al., 2013).
On one hand, a higher level of education could pro-
tect from cognitive loss and delay the overt expression
of dementia due to higher CR (Apolinario et al.,
2013). In this case, highly educated individuals have a
better capacity to compensate with normal or near
normal cognitive functioning in the presence of vary-
ing amounts of brain damage. On the other hand,
72.6 (4.5) rang 66–80
12 Men/15 Female
17.14 (3.21) range: 12–24
26.7 (3.23) range: 20.5–32.5
3 times a week
Between once to 3 times a week
1.5 h a week
2
Israel: 66.6%
Poland; Rumania: 7.4%
England; Egypt; Germany; Uzbekistan;
Argentina: 3.7%
1956 (10.41) range (1948–1976)
Hebrew: 70.3%
Yiddish: 11.1%
French; English; Hungarian; Russian; Spanish: 3.7%
Fluent Hebrew- 100%
Poland: 48.1%
Israel: 18.5%
Rumania: 11.1%
Russia: 7.4%
Italy; Ukraine; Greece; England: 3.7%
highly educated older adults are at high risk of being
under-diagnosed at the earliest stages of cognitive
decline (Elkana et al., 2016). These individuals, who
usually function far above the average norm from
young adulthood, may experience subjective decline
with aging relative to their own baseline, while object-
ively still perform within the age-matched norms
(Elkana et al., 2016). Although normative data strati-
fied by age and education have been available, the
studies tend to focus on the effect of lower education,
whereas there is a relatively minimal amount of
information regarding highly educated individuals
(O’Bryant et al., 2008). Therefore, in the present study
we wish to examine whether the IS reflects stable crys-
tallized ability in highly educated individuals, and if
so, whether the performance on this test is positively
correlated with gray matter brain volume. We
hypothesized that performances on the IS will be sta-
ble over time (T0, T1, T2, T3), relative to more fluid
cognitive abilities. In addition, we hypothesized that
IS will positively correlate with whole brain gray
matter volume (T0).
Materials and methods
Participants
Methods of this study were published elsewhere
(Elkana et al., 2016). In short, at baseline, 28 healthy
elderly adults were recruited. After the first year, one
participant was lost to follow up. Thus, the final sam-
ple included 27 participants ages 66–80 (Mean ¼ 72.6,
SD ¼ 4.5) with high educational level (see Table 1).

Data collection and diagnosis were performed in
the Center for Memory and Attention Disorders and
Functional Brain Center, TASMC. Participants
received nominal financial compensation for their
participation.
Inclusion Criteria: (1) Men and women over the
age of 65; and (2) Men and women with flu-
ent Hebrew.
Exclusion Criteria: (1) Diagnosis of cancer in the
last five years (we wished to include participants with
stable health that can be followed for years); (2)
Existence of a neurological or psychiatric disorder; (3)
History of head injuries and/or head surgeries; (4)
The presence of metals implanted in their bodies or
tattoos (MRI prohibition); and (5) Claustrophobia.
None of the participants reported significant cogni-
tive decline, and a board certified radiologist reviewed
all scans and found no significant lesions including
infarct, hemorrhage, or other brain lesions in any of
the subjects.
Procedure
The institutional ethics committee approved the
research and all participants signed informed consent.
The participants attended a screening exam in which
a highly structured clinical and neuropsychological
evaluation was administered (T0).
A brain MRI scan was conducted in a timeframe of
a few weeks after the first meeting (Mean 33 days).
Approximately 1 year after administration of the
cognitive assessment (T0), participants were invited
for follow-up assessments. Cognitive assessments iden-
tical to those obtained at T0 were repeated at yearly
intervals: T1 (1 year after the initial assessment), T2
(2 years after the initial assessment), and T3 (3 years
after the initial assessment). In addition, a depression
screening was performed, using the Beck Depression
Inventory questionnaire (BDI) due to the possible
impact of depression on individual’s cognitive
performance (Beck, Ward, Mendelson, Mock, &
Erbaugh, 1961).
Assessments
MRI data acquisition
 MRI scans were performed on a 3.0 Tesla MRI
scanner (GE Signa EXCITE, Milwaukee, WI, USA)
using an eight channel head coil. A high-resolution
anatomical T1-weighted fast spoiled gradient
echo image was acquired: FOV ¼ 256 mm;
APPLIED NEUROPSYCHOLOGY: ADULT 527
matrix ¼ 256  256; TR ¼ 9.2 ms; TE ¼ 3.5 ms; axial
slices of 1 mm thickness, no gap.
Neuropsychological Tests (for more detail, see
Elkana et al., 2016)
 Montreal Cognitive Assessment test (MoCA)
(Nasreddine et al., 2005): Screening test for MCI
that estimates different cognitive functions, includ-
ing attentiveness and concentration, executive
functioning, memory, language, visuo-construc-
tional ability, conceptual thinking, calculations, and
orientation.
 Rey Auditory Verbal Learning Test (RAVLT)
(Vakil & Blachstein, 1997): Provides an evaluation
of verbal episodic memory that includes immediate
memory (Trial 1 and Trail 6), learning rate (Trial
5 minus Trial 1), delayed memory (Trial 8), and
recognition (Trial 9). In addition, the introduction
of the interference list in Trial 6 (List B) enables
the extraction of two interference measures: pro-
active and retroactive interference. Proactive inter-
ference occurs when previously learned material
negatively affects the acquisition or recall of new
information. On the RAVLT it is expressed as
impaired learning of a new list (List B) after an
earlier learning list (List A) (the measure: Trial 1
minus Trial 6). Retroactive interference occurs
when subsequent material (List B) negatively
affects the recall of previously learned material
(List A). On the RAVLT it is measured by the
recall of List A after learning the distractor list
(List B) (the measure: Trial 5 minus Trial 7)
(Vakil, Greenstein, & Blachstein, 2010).
 Rey Osterrieth Complex Figure test (ROCF)
(Osterrieth, 1944): Measures visuospatial, episodic
nonverbal memory, attention, planning, working
memory, delayed memory, coordination, and graph
motor abilities. The test consists of two-test condi-
tions: copy and delayed recall.
The copy part involves mainly visual-constructional
and executive function abilities (specially planning
and organizing skills) and the delayed part involves
mainly nonverbal memory.
 Wechsler Adult Intelligence Scale (WAIS-III)
Information Subtest (IS) (Wechsler, 1997):
Includes questions of general knowledge. This test
expressed so-called “Crystallized intelligence,” and
is thought to represent premorbid abilities, which
often remain intact even in the face of major
brain damage.
528 O. ELKANA ET AL.
 WAIS-III Digit Span Forward and Backward
Subtest (Wechsler, 1997): Provides evaluation of
verbal attention and working memory.
 Trail Making Test (TMT), Parts A and B (Army
Individual Test Battery, 1944): provides informa-
tion of visual search, attention, speed processing,
mental flexibility, and executive functions. The
TMT consists of two parts. Part A is considered a
measure of visual search and mental tracking,
whereas Part B is assumed to encompass cognitive
abilities such as flexibility, to shift the course of an
ongoing activity and the capacity to deal with
more than one stimulus at a time (Fernandez &
Marcopulos, 2008).
 Verbal Fluency Test: Phonetic Fluency (PF) and
Semantic Fluency (SF) (Kav
e & Knafo-Noam,
2015): Examines retrieval of words, initiation and
mental flexibility. The test includes two parts; (1)
Phonemic Fluency (PF): letters Bet, Gimel, & Shin
in Hebrew; and (2) Semantic Fluency (SF): ani-
mals, fruits, & vegetables.
 BDI (Beck et al., 1961): One of the most common
tools for measuring the severity of depression. The
BDI consists of a list of descriptive statements
related to 21 aspects of depression. For each cat-
egory, there are four to five statements of increas-
ing severity. The participant reads the scale and
marks the statement most applicable to himself.
The score for each item ranges from 0 to 3; the
total score falls between 0 and 62 (Salkind, 1969).
Internal consistency for the BDI ranges from .73 to
.92 with a mean of .86 (Beck, Steer, & Carbin,
1988). In the present study, the internal consist-
ency was 0.79.
Data analysis
A whole-brain, voxel-based morphometry analysis was
conducted via Brain Voyager software (Goebel,
Esposito, & Formisano, 2006), using standard proce-
dures (Brain Voyager). Gray matter volume was calcu-
lated as a percentage from all brain matter as follows:
Gray matter/(Gray Matter þ White Matter þ Lateral
Ventricles). For more details, see Elkana et al. (2016).
Statistical analyses were performed using SPSS21
software. All tests, except the MoCA, were scored
using norms for age. These standardized scores
allowed comparison of different tests and examination
within subject variance. A descriptive statistical ana-
lysis of the characteristics of the sample was then con-
ducted. For the MoCA test, raw scores were used
since there are no formal norms for age (Lezak et al.,
2012). The association between brain volume and per-
formance on the IS was calculated using Pearson cor-
relations. Repeated measures ANOVA were performed
with TIME (T0/T1/T2/T3) as the within-subject vari-
able. A post hoc test (Bonferroni) was used to correct
for multiple comparisons to identify the significant
differences among the years.
Results
Cognitive differences between the four testing
examinations
There were no significant differences between per-
formances on the IS across examinations [Mean Z
score: T0 ¼ 1.39 (0.60); T1 ¼ 1.37 (0.77); T2 ¼ 1.50
(0.66); T3 ¼ 1.48 (0.66)].
On other tests, significant decline across TIME was
found in the ROCF-copy [F(3,78) ¼ 4.09, p < 0.01,
partial ¼ 0.13]; MOCA [F(3,78) ¼ 3.90, p < 0.05, parti-
al ¼ 0.13)]; and the RAVLT- proactive interference
[F(3,78)= 3.21, p < 0.05, partial ¼ 0.18].
On the contrary, significant improvement across
TIME was observed for the RAVLT-8 [F(3,78) ¼ 2.67,
p < 0.05, partial ¼ 0.10]; RAVLT-9 [F(3,78) ¼ 3.35,
p < 0.05, partial ¼ 0.11]; ROCF-delay [F(3,78)= 2.93,
p < 0.05, partial ¼ 0.10]; and the Trail Making test
(part A) [F(3,78) ¼ 10.39, p < 0.01, partial ¼ 0.28]
(Table 2).
Importantly, the observed changes in cognitive per-
formances were not likely due to mood changes, as
the participants were not depressed and there was no
significant effect of TIME on BDI scores.
Correlation of neuropsychological tests and
brain volume
We found a significant positive correlation between
gray matter percentage and IS score (at all four
examinations) (T0: r ¼ 0.45, p < 0.05), meaning that
individuals with a larger percentage of gray matter
performed better on the IS and vice versa
(Figure 1-T0).
This correlation was still significant after control-
ling for age and education as possible confounders
[partial correlation – age (T0): r ¼ 0.43; education
(T0): r ¼ 0.45, for both p < 0.05]. No other significant
correlations were found between gray matter percent-
age volume and other neuropsychological
tests (p > 0.05).
 APPLIED NEUROPSYCHOLOGY: ADULT 529

Table 2. Differences in cognitive performance between the four testing sessions T0–T3.
T0 T1 T2 T3 Repeated measures
Test/Questionnaire Z score (SD) Z score (SD) Z Score (SD) Z Score (SD) ANOVA F score (p)
RAVLT-1 0.13 (0.74) 0.04 (0.74) 0.27 (1.10) 0.35 (1.06) 1.57 (0.20)
RAVLT-5 0.06 (0.89) 0.07 (0.99) 0.07 (0.97) 0.19 (0.88) 0.42 (0.73)
RAVLT-6 0.39 (1.32) 0.25 (1.09) 0.04 (0.93) 0.12 (0.94) 1.83 (0.14)
RAVLT-7 0.17 (0.97) 0.01 (1.20) 0.27 (0.97) 0.37 (0.91) 2.53 (0.06)
RAVLT-8 0.38 (1.23) 0.29 (1.25) 0.11 (1.13) 0.23 (1.05) 2.67 (0.04)
RAVLT-9 0.04 (0.73) 0.03 (0.87) 0.38 (0.75) 0.43 (0.72) 3.35 (0.02)
Proactive Interference 0.50 (1.24) 0.23 (1.00) 0.17 (1.08) 0.20 (1.04) 3.21 (0.02)
Retroactive Interference 0.16 (1.05) 0.08 (0.99) 0.28 (0.96) 0.32 (0.94) 2.22 (0.09)
Total learning 0.02 (0.91) 0.10 (0.99) 0.36 (1.02) 0.49 (0.93) 2.20 (0.09)
ROCF-copy 1.29 (0.50) 0.81 (0.54) 0.85 (0.68) 0.92 (0.65) 4.09 (0.00)
ROCF-delayed 0.57 (0.75) 0.71 (0.84) 1.04 (0.85) 1.13 (0.88) 2.93 (0.03)
PF 0.28 (0.98) 0.34 (0.99) 0.51 (0.85) 0.40 (0.98) 0.44 (0.72)
SF 0.64 (1.11) 0.53 (1.04) 0.51 (1.20) 0.56 (1.06) 0.14 (0.93)
WAIS – digit span 0.14 (0.98) 0.26 (0.86) 0.09 (1.07) 0.09 (1.07) 0.38 (0.76)
TMT – A 0.01 (0.57) 0.16 (0.66) 0.43 (0.71) 0.71 (0.58) 10.39 (0.00)
TMT – B 0.63 (0.54) 0.66 (0.55) 0.84 (0.44) 0.84 (0.44) 1.51 (0.21)
IS 1.39 (0.60) 1.37 (0.77) 1.50 (0.66) 1.48 (0.66) 0.49 (0.68)
MoCA (raw score) 26.55 (1.50) 25.85 (1.45) 25.00 (2.16) 25.88 (1.94) 3.90 (0.01)
BDI (raw score) 4.70 (3.99) 5.81 (5.06) 6.55 (4.00) 5.48 (4.26) 1.18 (0.32)
Note. RAVLT ¼ Rey Auditory Verbal Learning Test; Proactive Interference ¼ Trial 1 minus Trial 6; Retroactive Interference ¼ Trial 5 minus Trial 7; Total
learning ¼ Sum of Trials 1 through 5; ROCF ¼ Rey Osterrieth Complex Figure test; PF ¼ Phonetic Fluency; SF ¼ Semantic Fluency; TMT ¼ Trail Making
Test Parts A and B; IS ¼ Information Subtest of WAIS-III; MoCa ¼ Montreal Cognitive Assessment test; BDI ¼ Beck Depression Inventory.
p < 0.05. p < 0.01.

Figure 1. Pearson Correlation: Percentage (%) gray matter and information subset.

Discussion based on executive functions are more sensitive for

In the present study we wished to examine whether the
IS of the WAIS-III reflected stable crystallized ability in
highly educated individuals, and if so, whether their
performance on this test was positively correlated with
gray matter brain volume. Our two hypotheses were
confirmed. First, our results demonstrate that in our
group, performance on the IS was stable across time
while other performances significantly decreased, albeit
still within the “normal range.” This latter intriguing
finding is discussed at length in Elkana et al. (2016).
Our findings strengthen the sensitivity of the ROCF-
copy and RAVLT, by showing persistent decline even
in a three-year follow-up, suggesting that tests that are
detecting subtle cognitive changes.
Interestingly, performance on certain tests improved
between the first and the fourth examinations (ROCF-
delay, RAVLT- Trials 8 & 9 and TMT- Part A). This
improvement would be commonly viewed as a practice
effect, which derives from repeated exposure to the test
materials (Duff, Callister, Dennett, & Tometich, 2012).
However, practice effects may result from different fac-
tors such as memory for specific test items, learned
strategies, or test sophistication (Calamia, Markon, &
Tranel, 2012). These factors can be divided into two
major components, familiarity with the task setup or
task demands, and familiarity with specific items, such
as words on a list or a story to be recalled (Goldberg,
530 O. ELKANA ET AL.
Harvey, Wesnes, Snyder, & Schneider, 2015). In the
present study, improvement was found in tests which
included a delayed part; the participants were already
familiar with the sequence of the tests and their expect-
ation of the delayed part might have led them to better
performance. In line with these results, Beglinger et al.
(2005) investigated the practice effect and showed sig-
nificant improvement on a wide range of neuropsycho-
logical tests. Similarly, several studies have found
practice effects to persist years after testing (R€onnlund,
Nyberg, B€ackman, & Nilsson, 2005; Van der Elst et al.,
2008), even after 7 years (Salthouse, Schroeder, &
Ferrer, 2004). These findings support and reinforce the
practice effect found in our study. Moreover, studies
showed that both higher IQ and greater education are
associated with larger practice effects on some tests
such as the TMT (Calamia et al., 2012), similar to our
finding regarding highly educated elders. Future
research should therefore investigate whether improve-
ment on certain tests could indirectly indicate higher
CR, reflecting adaptive mechanisms, which rapidly lead
to increased efficiency (Barulli & Stern, 2013).
Practice effects might also be associated with certain
cognitive domains. For example, the estimate of practice
effects for the visual memory domain was high, whereas
the estimate of practice effects for the visuospatial abil-
ity was low (Calamia et al., 2012; Wisdom, Mignogna,
& Collins, 2012). Our findings were consistent with this
pattern, showing improved performance on ROCF-
delay, which examines visual memory, but reduced per-
formance on ROCF-copy, which examines visuospatial
ability. Longitudinal assessments might therefore lead to
incorrect estimates of age-related cognitive changes
when not taking into consideration the impact of prac-
tice effects (Calamia et al., 2012). It is also possible that
part of the “improvements” observed in some tests and
in some subjects is due to crossing over from one
norm-interval to another.
Second, in the present study we found performance
on IS to be positively correlated with gray matter vol-
ume. General knowledge is stored mostly by multi-
modal areas in the brain; especially in gray matter.
The information subtest is one of the subtests which
contributes mostly to the general “g” factor (Nisbett
et al., 2012; McArdle, Ferrer-Caja, Hamagami, &
Woodcock, 2002) . These results are consistent with
the hypothesis of BR and strengthen the link between
BR and CR. The positive correlation between IS and
brain volume in a relatively homogenous group of
highly-educated individuals emphasizes that even in a
group located at the top end of the education scale,
there is strong association between CR and BR.
A few limitations should be mentioned. The sample
size was relatively small, and it will be important to
confirm these results in a larger sample of older
highly educated adults.
In addition, we used the Information subtest of the
WAIS-III. This is because, unfortunately, that is the
latest version (Adapted to Hebrew speakers) available
in Israel. The WAIS-III Information subtest is not
identical to the latest Information subtest of the
WAIS-IV (26 instead of 28 items, with 15 retained
and 11 new items, discontinue criterion, and revised
scoring). However, the information subtests of the
WAIS-III and of the WAIS-IV seem to have the same
structural configuration and appear to measure similar
constructs (Taub & Benson, 2013). Therefore, we
assume that the same patterns would emerge with the
WAIS-IV. Future longitudinal studies should also
combine computerized neuropsychological measure-
ments such as processing speed and include a com-
parison to a more heterogeneous group of individuals
with a wider range of educational level.
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