Education and the cognitive decline associated with MRI-defined brain infarct
Education and the cognitive decline associated with MRI-defined brain infarct
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DOI：
10.1212/01.wnl.0000228246.89109.98
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发表时间：
2006-08-08
期刊：
影响因子：
9.9
通讯作者：
Johnston, S. C.
中科院分区：
文献类型：
--
作者：
Elkins, J. S.;Longstreth, W. T., Jr.;Johnston, S. C.
目的：评估教育程度（认知储备的相关性）是否可以预测与新发脑梗塞相关的认知能力下降程度。方法：心血管健康研究是一项以人群为基础的纵向研究，对象为 65 岁及以上人群。每年使用改良简易精神状态检查 (3MS) 和数字符号替换测试 (DSST) 测量认知功能。作者测试了教育水平是否改变了 1) 认知表现与 MRI 定义的梗塞之间的横断面关联，以及 2) 与后续 MRI 中梗塞事件相关的认知功能变化。结果：在横断面分析中 (n = 3,660)，与其他人相比，MRI 定义的梗死对最低教育四分位数的 3MS 表现影响更大（异质性 p = 0.012）。在接受 MRI 随访且初次 MRI 未发现梗塞的患者中 (n = 1,433)，教育水平与新脑梗塞的发生率、大小或位置无关。然而，与其他组相比，新的 MRI 定义的梗死预测最低教育组的 3MS 评分下降幅度更大（下降 6.3，95% CI 4.4 至 8.2 点 vs 1.7，95% CI 下降 0.7 至 2.7 点；异质性 p < 0.001）。在 MRI 定义的梗塞情况下，高等教育与 DSST 表现较小的下降无关。结论：当发生脑梗塞时，教育似乎可以改变个体一般认知功能测试的下降。这些发现与认知储备影响大脑血管损伤影响的假设是一致的。
Objective: To assess whether educational attainment, a correlate of cognitive reserve, predicts the amount of cognitive decline associated with a new brain infarct. Methods: The Cardiovascular Health Study is a population-based, longitudinal study of people aged 65 years and older. Cognitive function was measured annually using the Modified Mini-Mental State Examination (3MS) and the Digit-Symbol Substitution Test (DSST). The authors tested whether education level modified 1) the cross-sectional association between cognitive performance and MRI-defined infarct and 2) the change in cognitive function associated with an incident infarct at a follow-up MRI. Results: In cross-sectional analysis (n = 3,660), MRI-defined infarct was associated with a greater impact on 3MS performance in the lowest education quartile when compared with others ( p for heterogeneity = 0.012). Among those with a follow-up MRI who had no infarct on initial MRI (n = 1,433), education level was not associated with the incidence, size, or location of new brain infarct. However, a new MRI- defined infarct predicted substantially greater decline in 3MS scores in the lowest education group compared with the others ( 6.3, 95% CI 4.4- to 8.2- point decline vs 1.7, 95% CI 0.7- to 2.7- point decline; p for heterogeneity < 0.001). Higher education was not associated with smaller declines in DSST performance in the setting of MRI- defined infarct. Conclusions: Education seems to modify an individual's decline on a test of general cognitive function when there is incident brain infarct. These findings are consistent with the hypothesis that cognitive reserve influences the impact of vascular injury in the brain.