教育改变了老年人中阿尔茨海默病病理学与认知功能水平之间的关系。

Education modifies the relation of AD pathology to level of cognitive function in older persons.

作者信息

Bennett D A, Wilson R S, Schneider J A, Evans D A, Mendes de Leon C F, Arnold S E, Barnes L L, Bienias J L

机构信息

Rush Alzheimer's Disease Center and Rush Institute for Healthy Aging, Chicago, IL 60612, USA.

出版信息

Neurology. 2003 Jun 24;60(12):1909-15. doi: 10.1212/01.wnl.0000069923.64550.9f.

DOI:10.1212/01.wnl.0000069923.64550.9f

PMID:12821732

Abstract

OBJECTIVE

To test the hypothesis that years of formal education modifies the relation of AD pathology to level of cognitive function.

METHODS

A total of 130 older Catholic clergy participating in the Religious Orders Study underwent annual cognitive function testing and brain autopsy at the time of death. Individual cognitive function tests were z-scored and averaged to yield a global measure of cognitive function and summary measures of five different cognitive abilities. Neuritic and diffuse plaques and neurofibrillary tangles were counted in separate 1 mm(2) areas of maximal density. Counts were converted to standard scores by dividing by their SD, and combined to yield a global AD pathology score and summary scores of each postmortem index. Linear regression was used to examine the relation of education and AD pathology scores to level of cognitive function proximate to death, controlling for age and sex. Subsequent analyses tested the interaction between education and each AD pathology score to determine whether education modified the relation of AD pathology to level of cognitive function. Additional analyses examined these associations on five specific cognitive abilities.

RESULTS

Both years of formal education (regression coefficient = 0.073, p = 0.0001) and the global AD pathology score (regression coefficient = -0.689, p < 0.0001) were related to level of cognitive function. When an interaction term between education and AD pathology was added to the model, the association between a unit of AD pathology and level of cognitive function was 0.088 (p = 0.0078) standard unit less for each year of education than the level predicted from the model without the interaction term. Whereas neuritic plaques, diffuse plaques, and neurofibrillary tangles were all strongly related to cognitive function, education only modified the relation of neuritic plaques (p = 0.002) and diffuse plaques (p = 0.03) to cognition, but not neurofibrillary tangles. In analyses examining five different cognitive abilities, the interaction between education and the neuritic plaque score was strongest for perceptual speed and weakest for episodic memory.

CONCLUSIONS

These data provide strong evidence that the relation between senile plaques and level of cognitive function differs by years of formal education.

摘要

目的

检验以下假设，即正规教育年限会改变阿尔茨海默病（AD）病理学与认知功能水平之间的关系。

方法

共有130名参与宗教团体研究的老年天主教神职人员在每年接受认知功能测试，并在死亡时进行脑部尸检。对个体认知功能测试进行z评分并求平均值，以得出认知功能的总体测量值以及五种不同认知能力的汇总测量值。在最大密度的单独1平方毫米区域内对神经炎斑和弥漫性斑块以及神经原纤维缠结进行计数。计数通过除以其标准差转换为标准分数，并合并以得出总体AD病理学评分以及每个死后指标的汇总分数。使用线性回归来检验教育程度和AD病理学评分与接近死亡时的认知功能水平之间的关系，并对年龄和性别进行控制。随后的分析测试了教育程度与每个AD病理学评分之间的相互作用，以确定教育程度是否改变了AD病理学与认知功能水平之间的关系。其他分析在五种特定认知能力上检验了这些关联。

结果

正规教育年限（回归系数 = 0.073，p = 0.0001）和总体AD病理学评分（回归系数 = -0.689，p < 0.0001）均与认知功能水平相关。当将教育程度与AD病理学之间的相互作用项添加到模型中时，每增加一年教育，单位AD病理学与认知功能水平之间的关联比无相互作用项的模型预测水平低0.088（p = 0.0078）个标准单位。虽然神经炎斑、弥漫性斑块和神经原纤维缠结均与认知功能密切相关，但教育程度仅改变了神经炎斑（p = 0.002）和弥漫性斑块（p = 0.03）与认知的关系，而未改变神经原纤维缠结与认知的关系。在对五种不同认知能力的分析中，教育程度与神经炎斑评分之间的相互作用在知觉速度方面最强，在情景记忆方面最弱。