From the Departments of Neurological Sciences (R.S.W., L.Y., J.A.S., D.A.B.), Behavioral Sciences (R.S.W., M.L., P.A.B.), and Pathology (J.A.S.), Rush University Medical Center, Rush Alzheimer's Disease Center, Chicago, IL.
Neurology. 2019 Mar 5;92(10):e1041-e1050. doi: 10.1212/WNL.0000000000007036. Epub 2019 Feb 6.
To assess the contribution of education to cognitive reserve.
Analyses are based on older participants in a longitudinal clinical-pathologic cohort study who had annual cognitive testing (n = 2,899) and subgroups that developed incident dementia (n = 696), died, and underwent a neuropathologic examination from which 10 neurodegenerative and cerebrovascular markers were derived (n = 752), or both (n = 405). Cognitive test scores were converted to a standard scale and averaged to yield composite measures of cognition.
Participants had a mean of 16.3 years of education (SD = 3.7, range 0-30). In all participants, education was associated with initial level of global cognition but not rate of cognitive change. In those who developed dementia, rate of global cognitive decline accelerated a mean of 1.8 years before the diagnosis, but education was not related to the onset or rate of accelerated decline. In the deceased, rate of global cognitive decline accelerated a mean of 3.4 years before death, but higher educational attainment was related to earlier (not later) onset of accelerated decline and unrelated to rate of acceleration. Higher education was associated with lower likelihood of gross and microscopic cerebral infarcts but not with other neuropathologic markers. Education was not related to global cognitive change not attributable to neuropathologic burden and did not decrease the association of higher neuropathologic burden with more rapid cognitive decline.
The results suggest that the contribution of education to cognitive reserve is limited to its association with level of cognitive function before old age.
评估教育对认知储备的贡献。
分析基于纵向临床病理队列研究中的老年参与者，他们每年进行认知测试（n=2899），并分为亚组，包括发生痴呆（n=696）、死亡和接受神经病理学检查的人群（n=752），从这些人群中得出 10 种神经退行性和脑血管标志物，或同时具有上述两种情况（n=405）。认知测试分数被转换为标准量表并平均，以得出认知的综合测量值。
参与者的平均受教育年限为 16.3 年（SD=3.7，范围 0-30）。在所有参与者中，教育与初始整体认知水平相关，但与认知变化的速度无关。在发生痴呆的人群中，整体认知下降的速度在诊断前平均加速了 1.8 年，但教育与发病或加速下降的速度无关。在死亡人群中，整体认知下降的速度在死亡前平均加速了 3.4 年，但较高的教育程度与更早（而非更晚）发生加速下降有关，与加速下降的速度无关。较高的教育程度与大面积和显微镜下脑梗死的可能性降低有关，但与其他神经病理学标志物无关。教育与神经病理学负担无关的认知变化无关，也不会降低较高的神经病理学负担与认知下降速度加快之间的关联。
结果表明，教育对认知储备的贡献仅限于其与老年前认知功能水平的关联。
