Albrecht Pierre, Perisse Jérémie, Sauleau Erik-André A, Blanc Frédéric
Pôle de gériatrie, CM2R, Hôpitaux universitaires de Strasbourg, France.
Département de Santé publique, Groupe méthode en recherche clinique (GRMC), Hôpitaux universitaires de Strasbourg, France, Laboratoire ICube, UMR 7357, Université de Strasbourg et CNRS, Strasbourg, France.
Geriatr Psychol Neuropsychiatr Vieil. 2021 Jun 1;19(2):229-235. doi: 10.1684/pnv.2021.0938.
To appraise the validity of the Yaakov Stern's theory, which postulates that the first cognitive deficits of Alzheimer's disease are delayed in patients with high cognitive reserve, compared to those with low cognitive reserve, but is subsequently associated with faster cognitive decline when cerebral lesions have reached some degree of severity. A retrospective study of 318 patients with Alzheimer's disease without associated cerebral disorders, was performed in the Memory Clinic of the University Hospital of Strasbourg. The patients were divided into 5 groups according to the degree of cognitive reserve assessed by the level of education (primary, middle school, intermediary, high school and higher education). Cognitive status was assessed by the scores on the Mini Mental Status at the first examination and during a 4-year or more follow-up. Slopes of cognitive decline were computed and compared between groups by ß linear regression. Patients in the higher education group had higher MMSE scores than those in the other groups at the first consultation, but a statistically significant steeper slope during the follow-up. Our results are congruent with the Stern's theoretical model, assuming that high cognitive reserve brings into play compensation mechanisms which hinder the onset of clinical cognitive decline in patients with Alzheimer's disease, but then is associated with a faster decline at a later stage when the reserve is exhausted.
为了评估雅科夫·斯特恩理论的有效性，该理论假定，与认知储备低的患者相比，认知储备高的阿尔茨海默病患者的首次认知缺陷出现延迟，但当脑损伤达到一定严重程度时，随后会伴随着更快的认知衰退。在斯特拉斯堡大学医院记忆门诊对318例无相关脑部疾病的阿尔茨海默病患者进行了一项回顾性研究。根据通过教育水平（小学、初中、中等、高中和高等教育）评估的认知储备程度，将患者分为5组。通过首次检查时和4年或更长时间随访期间的简易精神状态检查表得分评估认知状态。通过β线性回归计算并比较组间认知衰退斜率。高等教育组患者在首次就诊时的简易精神状态检查表得分高于其他组，但在随访期间有统计学意义的更陡斜率。我们的结果与斯特恩的理论模型一致，假设高认知储备会启动补偿机制，这会阻碍阿尔茨海默病患者临床认知衰退的发作，但随后在储备耗尽的后期会伴随着更快的衰退。
