Association Between Years of Education and Amyloid Burden in Patients With Subjective Cognitive Decline, MCI, and Alzheimer Disease

队列 认知功能衰退 阿尔茨海默病 疾病 医学 萧条(经济学) 高强度 队列研究 淀粉样蛋白(真菌学) 老年学 焦虑 痴呆 精神科 心理学 临床心理学 内科学 病理 磁共振成像 放射科 经济 宏观经济学
作者
Merle C. Hoenig,Daniele Altomare,Camilla Caprioglio,Lyduine E. Collij,Frederik Barkhof,Ronald Boellaard,Philip Scheltens,Gill Farrar,Mark Battle,Hendrik Theis,Kathrin Giehl,Gérard N. Bischof,Valentina Garibotto,José Luís Molinuevo,Oriol Grau‐Rivera,Julien Delrieu,Pierre Payoux,Jean‐Francois Démonet,Agneta Nordberg,Irina Savitcheva,Zuzana Walker,Paul Edison,Andrew Stephens,Rossella Gismondi,Frank Jessen,Chris Buckley,Juan Domingo Gispert,Giovanni B. Frisoni,Alexander Drzezga
出处
期刊:Neurology [Ovid Technologies (Wolters Kluwer)]
卷期号:102 (6)
标识
DOI:10.1212/wnl.0000000000208053
摘要

Higher-educated patients with Alzheimer disease (AD) can harbor greater neuropathologic burden than those with less education despite similar symptom severity. In this study, we assessed whether this observation is also present in potential preclinical AD stages, namely in individuals with subjective cognitive decline and clinical features increasing AD likelihood (SCD+).Amyloid-PET information ([18F]Flutemetamol or [18F]Florbetaben) of individuals with SCD+, mild cognitive impairment (MCI), and AD were retrieved from the AMYPAD-DPMS cohort, a multicenter randomized controlled study. Group classification was based on the recommendations by the SCD-I and NIA-AA working groups. Amyloid PET images were acquired within 8 months after initial screening and processed with AMYPYPE. Amyloid load was based on global Centiloid (CL) values. Educational level was indexed by formal schooling and subsequent higher education in years. Using linear regression analysis, the main effect of education on CL values was tested across the entire cohort, followed by the assessment of an education-by-diagnostic-group interaction (covariates: age, sex, and recruiting memory clinic). To account for influences of non-AD pathology and comorbidities concerning the tested amyloid-education association, we compared white matter hyperintensity (WMH) severity, cardiovascular events, depression, and anxiety history between lower-educated and higher-educated groups within each diagnostic category using the Fisher exact test or χ2 test. Education groups were defined using a median split on education (Md = 13 years) in a subsample of the initial cohort, for whom this information was available.Across the cohort of 212 individuals with SCD+ (M(Age) = 69.17 years, F 42.45%), 258 individuals with MCI (M(Age) = 72.93, F 43.80%), and 195 individuals with dementia (M(Age) = 74.07, F 48.72%), no main effect of education (ß = 0.52, 95% CI -0.30 to 1.58), but a significant education-by-group interaction on CL values, was found (p = 0.024) using linear regression modeling. This interaction was driven by a negative association of education and CL values in the SCD+ group (ß = -0.11, 95% CI -4.85 to -0.21) and a positive association in the MCI group (ß = 0.15, 95% CI 0.79-5.22). No education-dependent differences in terms of WMH severity and comorbidities were found in the subsample (100 cases with SCD+, 97 cases with MCI, 72 cases with dementia).Education may represent a factor oppositely modulating subjective awareness in preclinical stages and objective severity of ongoing neuropathologic processes in clinical stages.
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