Differential effects of cognitive reserve and brain reserve on cognition in Alzheimer disease
Differential effects of cognitive reserve and brain reserve on cognition in Alzheimer disease
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DOI：
10.1212/wnl.0000000000004802
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发表时间：
2018-01-09
期刊：
影响因子：
9.9
通讯作者：
Ossenkoppele, Rik
中科院分区：
文献类型：
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作者：
Groot, Colin;van Loenhoud, Anna C.;Ossenkoppele, Rik
目的探讨认知储备(CR)和脑储备(BR)对阿尔茨海默病(AD)认知功能的影响。方法663例AD生物标志物阳性的痴呆患者(疑似AD，n=462)或痴呆前期(临床前/前驱)AD患者(n=201)。教育程度作为CR的替代指标，颅内体积作为BR的替代指标。认知评估涉及5个领域(记忆、注意力、语言、视觉空间和执行功能)。我们使用多元线性回归模型来检验CR和BR对认知领域Z分数的影响，并对大脑萎缩进行了调整。此外，我们使用4个水平的变量(高CR/高CR、高CR/低BR、低CR/高BR和低CR/低BR)来评估不同疾病阶段和总储备程度的效果差异。病期分层显示痴呆前期组认知功能障碍对注意力和执行功能的影响大于痴呆组(分别为=0.39 vs=0.21[Welch t=2.40，p<；0.01]和=0.46 vs=0.26[t=2.83，p<；0.01])。此外，我们发现高CR/高BR组在所有领域的认知成绩都呈线性趋势，然后是高CR/低BR，低CR/高BR，然后是低CR/低BR(p
ObjectiveTo examine cross-sectional effects of cognitive reserve (CR) and brain reserve (BR) on cognition across the spectrum of Alzheimer disease (AD).MethodsWe included 663 AD biomarker-positive participants with dementia (probable AD, n = 462) or in the predementia stages (preclinical/prodromal AD, n = 201). Education was used as a proxy of CR and intracranial volume as a proxy of BR. Cognition was assessed across 5 domains (memory, attention, language, visuospatial, and executive functions). We performed multiple linear regression models to examine effects of CR and BR on cognitive domain Z scores, adjusted for cerebral atrophy. Furthermore, we assessed differences in effects according to disease stage and across degrees of total reserve using a 4-level variable (high CR/high BR, high CR/low BR, low CR/high BR, and low CR/low BR).ResultsWe found positive, independent effects of both CR and BR across multiple cognitive domains. Stratification for disease stage showed that effects of CR on attention and executive functioning were greater in predementia than in dementia ( = 0.39 vs = 0.21 [Welch t = 2.40, p < 0.01] and = 0.46 vs = 0.26 [t = 2.83, p < 0.01]). Furthermore, we found a linear trend for better cognitive performance in all domains in the high CR/high BR group, followed by high CR/low BR, low CR/high BR, and then low CR/low BR (p for trend