Association of life activities with cerebral blood flow in Alzheimer disease - Implications for the cognitive reserve hypothesis
Association of life activities with cerebral blood flow in Alzheimer disease - Implications for the cognitive reserve hypothesis
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DOI：
10.1001/archneur.60.3.359
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发表时间：
2003-03-01
影响因子：
--
通讯作者：
Stern, Y
中科院分区：
文献类型：
--
作者：
Scarmeas, N;Zarahn, E;Stern, Y
背景：局部脑血流量(CBF)是反映阿尔茨海默病(AD)脑病理改变的良好间接指标，在控制临床严重程度时，受教育程度和智商较高的患者下降更为严重。目的：评估病前参与各种活动是否也能提供认知储备。设计：我们评估了9名早期AD患者和16名接受脑(H2O)-O-15正电子发射断层扫描的健康老年人的智力、社交和体力活动。在控制了年龄和临床严重程度的体素多元回归分析中，我们调查了教育程度、病前智商估计、活动和CBF之间的关联。结果：根据先前的研究结果，我们在AD患者中复制了教育与CBF、智商和CBF之间的负关联。此外，先前报道的AD患者的活动评分与CBF呈负相关。当教育和智商作为协变量被添加到同一模型中时，活动分数越高，CBF缺陷就越明显。在对照组中没有发现显著的相关性。结论：在任何给定的临床疾病严重程度水平上，AD患者更多地参与活动，即使考虑到教育和智商，也有更大程度的脑病理参与。这可能表明，生活方式的个体差异可能通过部分中介脑损伤与AD临床表现之间的关系来影响认知储备。
Background: Regional cerebral blood flow (CBF), a good indirect index of cerebral pathologic changes in Alzheimer disease (AD), is more severely reduced in patients with higher educational attainment and IQ when controlling for clinical severity. This has been interpreted as suggesting that cognitive reserve allows these patients to cope better with the pathologic changes in AD.Objective: To evaluate whether premorbid engagement in various activities may also provide cognitive reserve.Design: We evaluated intellectual, social, and physical activities in 9 patients with early AD and 16 healthy elderly controls who underwent brain (H2O)-O-15 positron emission tomography. In voxelwise multiple regression analyses that controlled for age and clinical severity, we investigated the association between education, estimated premorbid IQ, and activities, and CBF.Results: In accordance with previous findings, we replicated an inverse association between education and CBF and IQ and CBF in patients with AD. In addition, there was a negative correlation between previous reported activity score and CBF in patients with AD. When both education and IQ were added as covariates in the same model, a higher activity score was still associated with more prominent CBF deficits. No significant associations were detected in the controls.Conclusions: At any given level of clinical disease severity, there is a greater degree of brain pathologic involvement in patients with AD who have more engagement in activities, even when education and IQ are taken into account. This may suggest that interindividual differences in lifestyle may affect cognitive reserve by partially mediating the relationship between brain damage and the clinical manifestation of AD.