Department of Neurology, Affiliated Lianyungang Hospital of Xuzhou Medical College, 182 Tongguan North Road, Lianyungang, Jiangsu 222002, China.
J Clin Neurosci. 2013 Apr;20(4):548-53. doi: 10.1016/j.jocn.2012.04.020. Epub 2013 Feb 11.
Cognitive reserve (CR) modulates the relationship between clinical and pathological phenotypes by restricting the negative effect of cerebral lesions on cognition, according to the CR hypothesis. In this study, we evaluated 18 healthy subjects and 21 patients with mild cognitive impairment (MCI) using conventional MRI, magnetic resonance spectroscopy (MRS), the Mini-Mental State Examination (MMSE), the Wechsler Memory Scale (WMS), and the Montreal Cognitive Assessment (MoCA). The MMSE, WMS and MoCA assessments were repeated 1year later. The MRS analysis results showed that the N-acetyl-aspartate peak area (NAA; t=5.122, P<0.001) and the NAA/creatine (Cr), NAA/myo-inositol (mI) and NAA/choline (Cho) ratios were significantly changed in patients with MCI compared with the control subjects (all P<0.01). The MoCA was significantly related to the NAA/Cho ratio (R=0.443), the NAA/Cr ratio (R=0.533), and the NAA peak area (R=0.814; all P<0.05), but was unrelated to the NAA/mI ratio (R=0.400, P=0.072). We found that the hippocampal volume was significantly correlated with the MoCA, WMS and MMSE (R=0.704, 0.677, 0.542 respectively; all P<0.05). Education level had a positive effect on changes in the MoCA, MMSE, and WMS 1year later. We believe that MoCA and WMS results, MRI hippocampal volume and other related indicators (NAA peak area, NAA/Cr ratio, NAA/mI ratio, and NAA/Cho ratio) may reflect the degree of CR capacity, and that the number of years of education can significantly affect the changes in cognitive function in patients with MCI. Therefore, increasing levels of education and life skills training can help increase CR, reduce the risk of MCI, and slow down the appearance of clinical manifestations and clinical progress in patients with MCI.
认知储备（CR）通过限制脑损伤对认知的负面影响来调节临床和病理表型之间的关系，这是 CR 假说的内容。在这项研究中，我们使用常规 MRI、磁共振波谱（MRS）、简易精神状态检查（MMSE）、韦氏记忆量表（WMS）和蒙特利尔认知评估（MoCA）评估了 18 名健康受试者和 21 名轻度认知障碍（MCI）患者。MMSE、WMS 和 MoCA 评估在 1 年后重复进行。MRS 分析结果显示，与对照组相比，MCI 患者的 N-乙酰天冬氨酸峰面积（NAA；t=5.122，P<0.001）以及 NAA/肌酸（Cr）、NAA/肌醇（mI）和 NAA/胆碱（Cho）比值均发生显著变化（均 P<0.01）。MoCA 与 NAA/Cho 比值（R=0.443）、NAA/Cr 比值（R=0.533）和 NAA 峰面积（R=0.814；均 P<0.05）显著相关，但与 NAA/mI 比值（R=0.400，P=0.072）无关。我们发现海马体积与 MoCA、WMS 和 MMSE 显著相关（R=0.704、0.677、0.542，均 P<0.05）。受教育程度对 MoCA、MMSE 和 WMS 1 年后的变化有积极影响。我们认为，MoCA 和 WMS 结果、MRI 海马体积和其他相关指标（NAA 峰面积、NAA/Cr 比值、NAA/mI 比值和 NAA/Cho 比值）可能反映了 CR 能力的程度，受教育年限可显著影响 MCI 患者认知功能的变化。因此，增加教育程度和生活技能训练可以帮助增加 CR，降低 MCI 的风险，并减缓 MCI 患者出现临床症状和临床进展的速度。
