Gonzalez-Gomez Raul, Cruzat Josephine, Hernández Hernán, Migeot Joaquín, Legaz Agustina, Santamaria-García Hernando, Fittipaldi Sol, Maito Marcelo Adrián, Medel Vicente, Tagliazucchi Enzo, Barttfeld Pablo, Franco-O'Byrne Daniel, Castro Laguardia Ana María, Borquez Patricio A, Avila-Funes José Alberto, Behrens María I, Custodio Nilton, Farombi Temitope, García Adolfo M, Garcia-Cordero Indira, Godoy Maria E, Campo Cecilia Gonzalez, Hu Kun, Lawlor Brian, Matallana Diana L, Miller Bruce, Okada de Oliveira Maira, Pina-Escudero Stefanie D, de Paula França Resende Elisa, Reyes Pablo, Slachevsky Andrea, Takada Leonel T, Yener Görsev G, Coronel-Oliveros Carlos, Ibañez Agustin
Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibañez, Santiago de Chile, Chile.
Global Brain Health Institute (GBHI), University of California, San Francisco, San Francisco, CA, USA.
EClinicalMedicine. 2025 Apr 10;82:103187. doi: 10.1016/j.eclinm.2025.103187. eCollection 2025 Apr.
While education is crucial for brain health, evidence mainly relies on individual measures of years of education (YoE), neglecting education quality (EQ). The effect of YoE and EQ on aging and dementia has not been compared.
We conducted a cross-sectional assessment of the effect of EQ and YoE on brain health in 7533 subjects from 20 countries, including healthy controls (HCs), Alzheimer's disease (AD), and frontotemporal lobar degeneration (FTLD). EQ was based on country-level quality indicators provided by the programme for international student assessment (PISA). After applying neuroimage harmonization, we examined its effect, along with YoE, on gray matter volume and functional connectivity. Regression models were adjusted for age, sex, and cognition, controlling for multiple comparisons. The influence of image quality was assessed through sensitivity analysis. Data collection was conducted between June 1 and October 30, 2024.
Less EQ and YoE were associated with brain alterations across groups. However, EQ had a stronger influence, mainly targeting the critical areas of each condition. At the whole-brain level, EQ influenced volume (HCs: Δmean = 2·0 [1·9-2·0] × 10, < 10; AD: Δmean = 0·1 [-0·0 to 0·3] × 10, = 0·18; FTLD: Δmean = 3·5 [3·0-4·0] × 10, < 10; all with 95% confidence intervals) and networks (HCs: Δmean = 13·5 [13·2-13·7] × 10, < 10; AD: Δmean = 5·9 [5·2-6·7] × 10, < 10; FTLD: Δmean = 13·2 [11·2-13·7] × 10, < 10) 1·3 to 7·0 times more than YoE. These effects remain robust despite variations in income and socioeconomic factors at country and individual levels.
The results support the need to incorporate education quality into studying and improving brain health, underscoring the importance of country-level measures.
Multi-partner consortium to expand dementia research in Latin America (ReDLat).
虽然教育对大脑健康至关重要，但证据主要依赖于对受教育年限（YoE）的个体衡量，而忽视了教育质量（EQ）。尚未比较受教育年限和教育质量对衰老及痴呆症的影响。
我们对来自20个国家的7533名受试者的教育质量和受教育年限对大脑健康的影响进行了横断面评估，这些受试者包括健康对照者（HCs）、阿尔茨海默病（AD）患者和额颞叶变性（FTLD）患者。教育质量基于国际学生评估项目（PISA）提供的国家层面质量指标。在应用神经影像归一化后，我们研究了其与受教育年限对灰质体积和功能连接性的影响。回归模型针对年龄、性别和认知进行了调整，以控制多重比较。通过敏感性分析评估图像质量的影响。数据收集于2024年6月1日至10月30日期间进行。
在所有组中，较低的教育质量和受教育年限均与大脑改变相关。然而，教育质量的影响更强，主要针对每种疾病的关键区域。在全脑水平上，教育质量对体积（健康对照者：平均变化量=2.0[1.9 - 2.0]×10，<0.001；阿尔茨海默病：平均变化量=0.1[-0.0至0.3]×10，=0.18；额颞叶变性：平均变化量=3.5[3.0 - 4.0]×10，<0.001；所有均为95%置信区间）和网络（健康对照者：平均变化量=13.5[13.2 - 13.7]×10，<0.001；阿尔茨海默病：平均变化量=5.9[5.2 - 6.7]×10，<0.001；额颞叶变性：平均变化量=13.2[11.2 - 13.7]×10，<0.001）的影响是受教育年限的1.3至7.0倍。尽管国家和个体层面的收入及社会经济因素存在差异，但这些影响仍然显著。
研究结果支持将教育质量纳入大脑健康研究及改善过程中的必要性，凸显了国家层面措施的重要性。
拉丁美洲痴呆症研究扩展多伙伴联盟（ReDLat）。
