Education, the brain and dementia: neuroprotection or compensation?
Education, the brain and dementia: neuroprotection or compensation?
复制标题
DOI：
10.1093/brain/awq185
复制
发表时间：
2010-08-01
期刊：
影响因子：
14.5
通讯作者：
Sulkava, Raimo
中科院分区：
文献类型：
--
作者：
Brayne, Carol;Ince, Paul G.;Sulkava, Raimo
教育对痴呆症的潜在保护作用是一个主要关注的领域。几乎所有老年人在死亡时都有一些脑部病变，但不一定死于痴呆症。我们在大型人群队列研究（欧洲流行病学临床病理学研究；EClipSE）中对死亡时脑病理、临床痴呆和教育时间之间的关系进行了调查，探索了这两个观察结果，验证了更多的教育可以降低痴呆风险的假设。EClipSE协调了纵向临床数据和神经病理学，这些数据来自三个长期的基于人群的研究，其中包括死后脑捐赠。这三项研究开始于1985年至1991年。早期生活中受教育年数以基线记录。通过随访访谈发现偶发性痴呆，并辅以回顾性的信息提供者访谈、死亡证明数据和死亡后相关的健康/社会记录（取决于研究）。在每项研究中，痴呆相关的神经病理学都是基于建立阿尔茨海默病登记联盟协议的可比方式进行评估的。其中包括872名脑捐赠者，其中56%在死亡时精神错乱。受教育年限越长，患痴呆症的风险越低，脑重量越大，但与神经退行性疾病或血管病变没有关系。神经病理变量与临床痴呆之间的关联根据教育的“剂量”而不同，例如更多的教育在很大程度上独立于病理的严重程度降低了痴呆的风险。更多的教育并不能保护人们在死前免受神经退行性疾病和血管神经病理学的影响，但它确实似乎减轻了病理学对死前痴呆临床表现的影响。研究结果表明，了解导致病理存在功能保护的机制可能对社会有相当大的价值。
The potential protective role of education for dementia is an area of major interest. Almost all older people have some pathology in their brain at death but have not necessarily died with dementia. We have explored these two observations in large population-based cohort studies (Epidemiological Clinicopathological Studies in Europe; EClipSE) in an investigation of the relationships of brain pathology at death, clinical dementia and time in education, testing the hypothesis that greater exposure to education reduces the risk of dementia. EClipSE has harmonized longitudinal clinical data and neuropathology from three longstanding population-based studies that included post-mortem brain donation. These three studies started between 1985 and 1991. Number of years of education during earlier life was recorded at baseline. Incident dementia was detected through follow-up interviews, complemented by retrospective informant interviews, death certificate data and linked health/social records (dependent on study) after death. Dementia-related neuropathologies were assessed in each study in a comparable manner based on the Consortium to Establish a Registry for Alzheimer's Disease protocol. Eight hundred and seventy-two brain donors were included, of whom 56% were demented at death. Longer years in education were associated with decreased dementia risk and greater brain weight but had no relationship to neurodegenerative or vascular pathologies. The associations between neuropathological variables and clinical dementia differed according to the 'dose' of education such that more education reduced dementia risk largely independently of severity of pathology. More education did not protect individuals from developing neurodegenerative and vascular neuropathology by the time they died but it did appear to mitigate the impact of pathology on the clinical expression of dementia before death. The findings suggest that an understanding of the mechanisms leading to functional protection in the presence of pathology may be of considerable value to society.