Positive Effects of Education on Cognitive Functioning Depend on Clinical Status and Neuropathological Severity.
Positive Effects of Education on Cognitive Functioning Depend on Clinical Status and Neuropathological Severity.
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DOI：
10.3389/fnhum.2021.723728
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发表时间：
2021
影响因子：
2.9
通讯作者：
Oosterman JM
中科院分区：
文献类型：
--
作者：
Jansen MG;Geerligs L;Claassen JAHR;Overdorp EJ;Brazil IA;Kessels RPC;Oosterman JM
背景：健康和病理性衰老中认知功能的变异性通常可以用教育程度来解释。然而，目前还不清楚不同的疾病状态会在多大程度上改变教育的保护效果。我们的目的是调查教育对认知的保护作用是否取决于(1)临床诊断的严重性，以及(2)记忆诊所诊断中的神经病理负担。方法：在这项横断面研究中，108例主观性认知功能减退患者[SCD，中位年龄71岁，智商(66-78)，男性占43%]，190例轻度认知损害[MCI，中位年龄78岁，智商(73-82)，男性占44%]，以及245例阿尔茨海默病痴呆(AD)[中位年龄80岁，智商(76-84)，男性占35%]。我们将海马区萎缩、整体萎缩和MRI上白质高信号的视觉评分合并为一个单一的神经病理学评分。为了调查教育对认知表现的贡献是否在SCD、MCI和AD中有所不同，我们采用了几个多元线性回归模型，按诊断分层，并根据年龄、性别和神经变性进行调整。我们用额外的交互作用项重新运行每个模型，以研究这些影响是否分别受到每个诊断组的神经病理负担的影响。应用多次比较的错误发现率(FDR)校正。结果：我们观察到，在全球认知和执行功能方面，教育与表现之间存在显著的正相关(所有调整后的p值均为0.05)。然而，随着诊断变得更加严重，这些关联的强度降低(所有调整后的p值均为0.05)。与情景记忆相关的教育仅在SCD的神经病理水平较低时(β=−=0.23，未校正p=0.02)，而在具有较高神经病理水平的患者中与情景记忆有关的教育(β=0.15，未校正p=0.04)。然而，这些相互作用的影响并没有经受住罗斯福的修正。结论：总而言之，我们的结果表明，教育对认知功能的积极影响随着诊断的严重程度而降低，但神经病理负担在特定诊断中的作用很小，值得进一步研究。未来的研究可能会进一步揭示个人疾病严重性的不同维度在多大程度上有助于认知衰老中保护作用的增强和减弱。
Background: Variability in cognitive functions in healthy and pathological aging is often explained by educational attainment. However, it remains unclear to which extent different disease states alter protective effects of education. We aimed to investigate whether protective effects of education on cognition depend on (1) clinical diagnosis severity, and (2) the neuropathological burden within a diagnosis in a memory clinic setting. Methods: In this cross-sectional study, we included 108 patients with subjective cognitive decline [SCD, median age 71, IQR (66–78), 43% men], 190 with mild cognitive impairment [MCI, median age 78, IQR (73–82), 44% men], and 245 with Alzheimer’s disease dementia (AD) [median age 80, IQR (76–84), 35% men]. We combined visual ratings of hippocampal atrophy, global atrophy, and white matter hyperintensities on MRI into a single neuropathology score. To investigate whether the contribution of education to cognitive performance differed across SCD, MCI, and AD, we employed several multiple linear regression models, stratified by diagnosis and adjusted for age, sex, and neurodegeneration. We re-ran each model with an additional interaction term to investigate whether these effects were influenced by neuropathological burden for each diagnostic group separately. False discovery rate (FDR) corrections for multiple comparisons were applied. Results: We observed significant positive associations between education and performance for global cognition and executive functions (all adjusted p-values < 0.05). As diagnosis became more severe, however, the strength of these associations decreased (all adjusted p-values < 0.05). Education related to episodic memory only at relatively lower levels of neuropathology in SCD (β = −0.23, uncorrected p = 0.02), whereas education related to episodic memory in those with higher levels of neuropathology in MCI (β = 0.15, uncorrected p = 0.04). However, these interaction effects did not survive FDR-corrections. Conclusions: Altogether, our results demonstrated that positive effects of education on cognitive functioning reduce with diagnosis severity, but the role of neuropathological burden within a particular diagnosis was small and warrants further investigation. Future studies may further unravel the extent to which different dimensions of an individual’s disease severity contribute to the waxing and waning of protective effects in cognitive aging.
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