Educational attainment and motor burden in advanced Parkinson's disease - The emerging role of education in motor reserve
Educational attainment and motor burden in advanced Parkinson's disease - The emerging role of education in motor reserve
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DOI：
10.1016/j.jns.2017.08.3241
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发表时间：
2017-10-15
影响因子：
4.4
通讯作者：
Lange, Max
中科院分区：
文献类型：
--
作者：
Blume, Josefine;Rothenfusser, Eva;Lange, Max
目的：探讨晚期帕金森病患者运动负荷与受教育程度的关系。材料和方法：我们纳入了102例连续患者，他们接受了DBS手术的完整评估，包括详细的神经心理测试和标准化左旋多巴挑战中的UPDRSIII。教育年数（YoE）的计算方法为中学达到的最高成绩加上中学后的培训年数。结果：在我们的多变量线性回归模型中，OFF药物UPDRS-III评分与YoE （p = 0.006; t = -2.82）和年龄（p = 0.007; t = -2.75）相关，即使包括疾病持续时间（p = 0.8; t = 0.21）、轻度认知障碍（MCI）的存在（p = 0.9; t = 0.16）或当前智商（p = 0.2; t = 1.25）作为附加的辅助变量。在DBS后两年的60例患者亚组中，ON/ON UPDRS评分与YoE （p = 0.01, t = -2.42）和PD痴呆的诊断（p = 0.05, t = 1.95）相关，而年龄（p = 0.08, t = 1.75）、病程（p = 0.6, t = 0.48）和LEDD （p = 0.3, t = 1.05）与ON/ON UPDRS评分无显著相关性。结论：在调整了重要的协变量后，我们发现受教育年限与较低（更好）的UPDRS-III运动评分之间存在负相关。教育可能会增加对基底神经节回路紊乱的补偿能力，这种紊乱不仅影响PD的认知，也影响PD的运动方面。因此，受教育程度可能在运动储备的概念中起重要作用。
Objective: To explore the relationship of motor burden and educational attainment in patients with advanced stage PD.Materials and methods: We included 102 consecutive patients who underwent a complete evaluation for DBS surgery, including detailed neuropsychological testing and UPDRSIII in a standardized Levodopa challenge. Years of education (YoE) were calculated as the highest grade attained in secondary school plus years for post-secondary training.Results: The OFF medication UPDRS-III score was associated with YoE (p = 0.006; t = -2.82) and age (p = 0.007; t = -2.75) in our multivariable linear regression model even while including disease duration (p = 0.8; t = 0.21), presence of mild cognitive impairment (MCI) (p = 0.9; t = 0.16) or current IQ (p = 0.2; t = 1.25) as additional covariables. In a subgroup of 60 patients two years after DBS, the ON/ON UPDRS score was associated with YoE (p = 0.01; t = -2.42) and diagnosis of PD dementia (p = 0.05, t = 1.95), while age (p = 0.08, t = 1.75), disease duration (p = 0.6 t = 0.48) and LEDD (p = 0.3; t = 1.05) showed no significant association to ON/ON UPDRS score.Conclusions: We found an inverse correlation between years of education and lower (better) UPDRS-III motor score after adjusting for important covariables. Education may lead to an increased ability to compensate disturbances in basal ganglia circuits affecting not only for cognitive, but also for motor aspects of PD. Thus, educational attainment may play an important role in the concept of motor reserve.