Education and cognitive resilience: what is the role of education characteristics in shaping an ability to maintain high levels of cognitive functioning after the onset of disease

项目摘要 偶发性卒中常伴有急性功能障碍和认知能力下降，以及长期中风。 认知衰退的术语加速。这些由此导致的损伤和痴呆症极大地影响了生活质量， 中风后痴呆症患者死亡和残疾的风险增加。教育一直是 一直被认为是中风后认知的预测因素，但这种关系背后的机制并不是 完全理解。一种假说认为认知韧性，认为教育为个人提供 使用认知工具在临床上有意义的神经退行性变中保持认知功能 或受伤。然而，对这种关系的研究由于缺乏普遍接受的 认知韧性。此外，一些研究表明，衡量受教育程度的常用标准 可能无法反映认知的差异以及其他衡量标准，如教育质量和识字能力。 中风和痴呆症之间的关系有可能被用于研究认知韧性 和储备，这是认知老化研究中的一个关键问题。通过将中风作为一种明确定义和明确诊断的 具有已知事件发生时间的疾病，可以进行研究以评估 教育亚组并区分正常年龄相关的减退和疾病相关的病理 流程。因此，这项建议旨在调查教育特征对 中风后的认知弹性。认知复原力将以三种不同的方式概念化：认知 中风后数年的下降(目标1)、有中风病史的患者患痴呆症的风险(目标2)和认知能力 测试与血管损伤的成像标记物相关的性能(目标3)。分析将使用现有数据， 教育以研究参与者和州、年、种族的自我报告年限来衡量- 教育质量特征的具体衡量标准：平均学时、生师比、 出勤率来自国家教育统计中心的历史数据。目标1将使用一个全国性的 代表性数据集，通过两年一次的跟踪调查评估，最大限度地提高教育经验的多样性 中风后下降，目标2和目标3将包括一家大型管理型医疗组织的成员，该组织具有详细的 整个成年期的病史和临床神经病理成像测量。 这项建议将解决对教育影响背后的机制的理解差距 中风后的认知弹性。这项研究的知识将直接解决NIA澄清以下问题的使命 对认知韧性和储备的理解，以及对认知决定因素的理解优先 衰老。拟议的培训由模范的专家导师团队指导，将提高申请者的素质 研究能力、内容专业知识和严谨的方法技能是推进她的职业生涯所需的 一位独立的学术研究人员专注于健康认知老化的生命周期决定因素。

Project Summary Incident stroke is often accompanied by acute deficits and declines in cognitive ability as well as long- term acceleration of cognitive decline. These resulting impairments and dementia drastically affect quality of life, and patients with dementia after stroke are at increased risk of death and disability. Education has been consistently identified as a predictor of cognition after stroke, but mechanisms behind this relationship are not fully understood. One hypothesis considers cognitive resilience, suggesting that education provides individuals with cognitive tools to maintain cognitive functioning amidst a clinically meaningful amount of neurodegeneration or injury. However, studies of this relationship are hindered by a lack of universally accepted definitions of cognitive resilience. Furthermore, some studies suggest that the commonly used measure of attained education may not capture variation in cognition as well as alternative measures such as educational quality and literacy. The relationship between stroke and dementia has the potential to be used to study cognitive resilience and reserve, a critical issue in cognitive aging research. By using stroke as a well-defined and clearly diagnosed disease with a known time of event onset, studies can be conducted to assess for differences between educational subgroups and to differentiate between normal-age related decline and disease-related pathological processes. Therefore, this proposal aims to investigate the influence of educational characteristics on cognitive resilience after stroke. Cognitive resilience will be conceptualized in three distinct ways: cognitive decline in years following stroke (Aim 1), risk of dementia in patients with history of stroke (Aim 2), and cognitive testing performance in relation to imaging markers of vascular injury (Aim 3). Analyses will use existing data, with education measured as self-reported years attained from study participants and state-, year-, and race- specific measures of educational quality characteristics of average term length, student-to-teacher ratio, and attendance ratio from historical data from the National Center for Education Statistics. Aim 1 will use a nationally representative dataset to maximize variation in educational experiences with biennial follow-up surveys to assess decline after stroke, and Aims 2 and 3 will include members of a large managed care organization with detailed medical histories throughout adulthood and clinical neuropathologic imaging measures. This proposal will address the gap in understanding of mechanisms behind the influence of education on cognitive resilience after stroke. Knowledge from this research will directly address the NIA’s mission of clarifying understanding of cognitive resilience and reserve, and the priority of understanding determinants of cognitive aging. The proposed training, guided by an exemplary mentorship team of experts, will enhance the applicants research competency, content expertise, and rigorous methodological skills needed to advance her career as an independent academic researcher focused on lifecourse determinants of healthy cognitive aging.