From the Department of Neurology and Alzheimer Center (C.G., A.C.v.L., P.S., W.M.v.d.F., R.O.) and Departments of Radiology and Nuclear Medicine (C.G., F.B., B.N.M.v.B., R.O.), Medical Psychology (T.K.), Clinical Chemistry (C.C.T.), and Epidemiology and Biostatistics (W.M.v.d.F.), VU University Medical Center, Amsterdam, the Netherlands; and Institutes of Neurology & Healthcare Engineering (F.B.), University College London, UK.
Neurology. 2018 Jan 9;90(2):e149-e156. doi: 10.1212/WNL.0000000000004802. Epub 2017 Dec 13.
To examine cross-sectional effects of cognitive reserve (CR) and brain reserve (BR) on cognition across the spectrum of Alzheimer disease (AD).
We included 663 AD biomarker-positive participants with dementia (probable AD, n = 462) or in the predementia stages (preclinical/prodromal AD, n = 201). Education was used as a proxy of CR and intracranial volume as a proxy of BR. Cognition was assessed across 5 domains (memory, attention, language, visuospatial, and executive functions). We performed multiple linear regression models to examine effects of CR and BR on cognitive domain scores, adjusted for cerebral atrophy. Furthermore, we assessed differences in effects according to disease stage and across degrees of total reserve using a 4-level variable (high CR/high BR, high CR/low BR, low CR/high BR, and low CR/low BR).
We found positive, independent effects of both CR and BR across multiple cognitive domains. Stratification for disease stage showed that effects of CR on attention and executive functioning were greater in predementia than in dementia (β = 0.39 vs β = 0.21 [Welch = 2.40, < 0.01] and β = 0.46 vs β = 0.26 [ = 2.83, < 0.01]). Furthermore, we found a linear trend for better cognitive performance in all domains in the high CR/high BR group, followed by high CR/low BR, low CR/high BR, and then low CR/low BR ( for trend <0.05).
CR and BR both independently mitigate cognitive symptoms in AD. The positive effect of CR is most strongly expressed in the predementia stages and the additive effects of high CR and BR are most beneficial.
探讨认知储备（CR）和大脑储备（BR）对阿尔茨海默病（AD）谱系认知的横断面影响。
我们纳入了 663 名 AD 生物标志物阳性的痴呆患者（可能的 AD，n=462）或处于痴呆前阶段（临床前/前驱 AD，n=201）。教育被用作 CR 的替代指标，而颅内体积被用作 BR 的替代指标。认知在 5 个领域（记忆、注意力、语言、视空间和执行功能）进行评估。我们进行了多元线性回归模型，以检查 CR 和 BR 对认知领域评分的影响，调整了脑萎缩。此外，我们使用 4 级变量（高 CR/高 BR、高 CR/低 BR、低 CR/高 BR 和低 CR/低 BR）评估了根据疾病阶段和总储备程度的差异。
我们发现 CR 和 BR 在多个认知领域都有积极的、独立的影响。疾病阶段分层表明，CR 对注意力和执行功能的影响在痴呆前阶段比痴呆阶段更大（β=0.39 对β=0.21 [Welch =2.40，<0.01]和β=0.46 对β=0.26 [=2.83，<0.01]）。此外，我们发现高 CR/高 BR 组在所有领域的认知表现都呈线性趋势，其次是高 CR/低 BR、低 CR/高 BR，最后是低 CR/低 BR（趋势检验<0.05）。
CR 和 BR 都独立地减轻 AD 中的认知症状。CR 的积极作用在痴呆前阶段最为明显，而高 CR 和 BR 的加性作用最为有益。
