Busatto Geraldo F, de Gobbi Porto Fabio Henrique, Faria Daniele de Paula, Squarzoni Paula, Coutinho Artur Martins, Garcez Alexandre Teles, Rosa Pedro Gomes Penteado, da Costa Naomi Antunes, Carvalho Cleudiana Lima, Torralbo Leticia, de Almeida Hernandes Jullie Rosana, Ono Carla Rachel, Brucki Sonia Maria Dozzi, Nitrini Ricardo, Buchpiguel Carlos Alberto, Souza Duran Fabio Luis, Forlenza Orestes Vicente
Laboratory of Psychiatric Neuroimaging (LIM 21) Department of Psychiatry Faculdade de Medicina FMUSP Universidade de Sao Paulo Sao Paulo Brazil.
Laboratory of Nuclear Medicine (LIM43) Department of Radiology and Oncology Faculdade de Medicina FMUSP Universidade de Sao Paulo Sao Paulo Brazil.
Alzheimers Dement (Amst). 2020 Dec 8;12(1):e12122. doi: 10.1002/dad2.12122. eCollection 2020.
Reduced cognitive reserve (CR) due to very low educational (VLE) levels may influence high dementia rates in low-middle income environments, leading to decreased cognitive resilience (RES) to Alzheimer´s disease (AD) pathology. However, findings in VLE groups confirming this prediction are lacking.
Cognitively impaired patients (with clinically defined AD dementia or amnestic mild cognitive impairment) and cognitively unimpaired older adults (n = 126) were recruited for a positron emission tomography (PET) and magnetic resonance imaging (MRI) investigation in Brazil, including 37 VLE individuals (≤5 years of education). A CR score was generated combining educational attainment and vocabulary knowledge. RES indices to AD pathology were calculated using standardized residuals from linear regression models relating current cognitive performance (episodic memory or overall cognition) to amyloid beta (Aβ) burden Pittsburgh compound-B ([11C]PiB-PET).
Aβ burden was lower in VLE relative to highly-educated subjects (controlling for age, sex, and Mini-Mental Status Exam [MMSE] scores) in the overall cognitively impaired sample, and in dementia subjects when the three clinically defined groups were evaluated separately. In bivariate regression analyses for the overall sample, the RES index based on a composite cognitive score was predicted by CR, socioeconomic status, and hippocampal volume (but not white matter hyperintensities or intracranial volume [ICV]); in the multivariate model, only CR retained significance (and similar results were obtained in the Aβ-positive subsample). In the multivariate model for the overall sample using the RES index based on memory performance, CR, hippocampal volume, and ICV were significant predictors, whereas only CR retained significance in Aβ-positive subjects.
Lower CR consistently predicted less resilience to AD pathology in older adults from a low-middle income environment.
由于教育水平极低（VLE）导致的认知储备（CR）降低，可能会影响中低收入环境中较高的痴呆症发病率，导致对阿尔茨海默病（AD）病理的认知恢复力（RES）下降。然而，缺乏VLE组中证实这一预测的研究结果。
在巴西招募了认知受损患者（临床诊断为AD痴呆或遗忘型轻度认知障碍）和认知未受损的老年人（n = 126）进行正电子发射断层扫描（PET）和磁共振成像（MRI）研究，其中包括37名VLE个体（受教育年限≤5年）。通过结合受教育程度和词汇知识生成CR分数。使用线性回归模型的标准化残差计算AD病理的RES指数，该模型将当前认知表现（情景记忆或整体认知）与淀粉样蛋白β（Aβ）负荷匹兹堡化合物B（[11C]PiB-PET）相关联。
在整体认知受损样本中，相对于高学历受试者（控制年龄、性别和简易精神状态检查表[MMSE]分数），VLE个体的Aβ负荷较低；在分别评估三个临床定义组时，痴呆症受试者中也是如此。在对整体样本的双变量回归分析中，基于综合认知分数的RES指数由CR、社会经济地位和海马体积预测（但不是白质高信号或颅内体积[ICV]）；在多变量模型中，只有CR保持显著意义（在Aβ阳性子样本中获得了类似结果）。在使用基于记忆表现的RES指数对整体样本进行的多变量模型中，CR、海马体积和ICV是显著预测因子，而在Aβ阳性受试者中只有CR保持显著意义。
较低的CR持续预测中低收入环境中老年人对AD病理的恢复力较低。
