Foundation for Biomedical Research Getafe University Hospital, Getafe, Madrid.
Department of Epidemiology and Biostatistics, University of California, San Francisco.
Alzheimer Dis Assoc Disord. 2019 Jul-Sep;33(3):179-185. doi: 10.1097/WAD.0000000000000321.
To use neuropsychological assessments for studying the underlying disease processes contributing to dementia, it is crucial that they correspond to magnetic resonance imaging (MRI)-based measures of dementia, regardless of educational level.
French 3-City Dijon MRI study cohort members (n=1782) with assessments of white matter lesion volume (WMLV), hippocampal volume (HCV), and cerebrospinal fluid volume (CSFV), and 6 waves of neuropsychological assessments over 11 years, including Mini-Mental State Examination (MMSE), plus 5 other tests combined using a Z-score or item-response theory (IRT-cognition) comprised the study cohort. We evaluated, testing interactions, whether education modified associations of MRI markers with intercept or rate of change of MMSE, Z-score composite, or IRT-cognition.
In linear models, education modified the associations of WMLV and CSFV with MMSE and CSFV and Z-score composite. In mixed models, education modified the associations of WMLV and CSFV with level of MMSE and the association of HCV with slope of MMSE. Education also modified the association with CSFV and slope of Z-score composite decline. There was no evidence that education modified associations between MRI measures and level or slope of IRT-cognition.
Longitudinal analysis of correctly scaled neuropsychological assessments may provide unbiased proxies for MRI-based measures of dementia risk.
为了使用神经心理学评估来研究导致痴呆的潜在疾病过程，这些评估必须与基于磁共振成像（MRI）的痴呆测量方法相对应，而与教育程度无关。
法国 3 个城市第戎 MRI 研究队列成员（n=1782）接受了白质病变体积（WMLV）、海马体积（HCV）和脑脊液体积（CSFV）的评估，以及 11 年 6 波的神经心理学评估，包括 Mini-Mental State Examination（MMSE），以及使用 Z 分数或项目反应理论（IRT-认知）组合的另外 5 项测试。我们评估了教育是否改变了 MRI 标志物与 MMSE、Z 分数综合和 IRT-认知的截距或变化率之间的关联，同时测试了交互作用。
在线性模型中，教育程度改变了 WMLV 和 CSFV 与 MMSE 和 CSFV 与 Z 分数综合的相关性。在混合模型中，教育程度改变了 WMLV 和 CSFV 与 MMSE 水平以及 HCV 与 MMSE 斜率的相关性。教育程度还改变了与 CSF 相关的 Z 分数综合下降斜率的相关性。没有证据表明教育程度改变了 MRI 测量值与 IRT-认知的水平或斜率之间的相关性。
经过正确缩放的神经心理学评估的纵向分析可能为基于 MRI 的痴呆风险测量提供无偏倚的替代方法。
