Researchers in Germany have discovered that formal education can help stave off Alzheimer’s disease symptoms, even if the brain has developed physical characteristics of the disease, according to a new study.

Previous studies have suggested a link between formal education and protection against cognitive decline, and that more years of education help stave off Alzheimer’s. But in those studies, the brain’s pathology was examined after a patient died. This is the first study to look at the correlation between education, Alzheimer’s disease and cognitive function using magnetic resonance imaging (MRI) on living subjects. Researchers found that even among subjects with significantly diminished brain size due to Alzheimer’s pathologies, higher levels of formal education could protect against the cognitive effects of the disease.

More than 270 people participated in the study, and plans for further research with a larger cohort are in the works, researchers say. The study appears in the August edition of the Journal of Alzheimer’s Disease.