Department of Physical & Medical Rehabilitation, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.
Department of Psychology, and Leslie and Susan Gonda (Goldschmied) Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel.
J Clin Exp Neuropsychol. 2024 Sep;46(7):683-692. doi: 10.1080/13803395.2024.2400109. Epub 2024 Sep 5.
The present study examined the cognitive reserve (CR) theory at late stages of Alzheimer's disease (AD). The objective is to replicate previous studies and examine the complex role of education and family size as indicators of CR.
This is a retrospective study included 642 patients diagnosed with AD after age 65, categorized into low education (LE, ≤ 8 years, = 141) and medium-high education (MHE, ≥ 9 years, = 442) groups. Participants were followed up longitudinally using the Mini Mental State Examination.
Higher education in the MHE group, but not in the LE group, correlated with delayed diagnosis. In both groups, higher education correlated with accelerated cognitive decline. In the MHE group, country of origin was associated with cognitive decline, while in the LE group, it was linked to family size.
This study shows that in patients with MHE but not in LE, higher education resulted in delayed diagnosis. Conversely, in cases of LE, this measure may not fully reflect CR and abilities. Additionally, higher education was associated with faster deterioration, a finding that has not been replicated often in the literature. The study illustrates the complex impact of CR proxies on age of diagnosis and cognitive decline.
本研究在阿尔茨海默病（AD）的晚期阶段检验认知储备（CR）理论。目的是复制先前的研究，并检验教育程度和家庭规模作为 CR 指标的复杂作用。
这是一项回顾性研究，纳入了 642 名 65 岁后被诊断为 AD 的患者，分为低教育（LE，≤8 年，=141）和中高教育（MHE，≥9 年，=442）组。参与者使用简易精神状态检查进行纵向随访。
MHE 组的高教育程度，而不是 LE 组，与延迟诊断相关。在两组中，高教育程度与认知衰退加速相关。在 MHE 组中，原籍国与认知衰退相关，而在 LE 组中，与家庭规模相关。
本研究表明，在 MHE 组而非 LE 组中，较高的教育程度导致了延迟诊断。相反，在 LE 组中，该措施可能无法完全反映 CR 和能力。此外，较高的教育程度与更快的恶化相关，这一发现在文献中并不常见。该研究说明了 CR 代理对诊断年龄和认知衰退的复杂影响。
