Better memory with literacy acquisition later in life: a randomized controlled trial

摘要 痴呆症是一种流行病，预计到2050年将造成1.2万亿美元的损失。目前，2/3的痴呆症患者生活在 中低收入国家（LMIC）。30%的痴呆症病例可以通过改变风险因素来预防， 低学历。在生命早期获得的正规教育可以预防痴呆症，但是否获得 晚年接受教育可以降低痴呆症的风险，这一点尚不清楚。我们以前的横向工作在 巴西/UFMG与美国/UCSF合作表明，即使是几年的教育也可能改善大脑 通过加强情景记忆和内侧颞叶结构之间的关系， 包括海马体（HC）及其连接。成年后接受教育是否也能 加强这些联系和增加海马效率是未知的。我们开始了一个单臂飞行员 一项纵向研究，以确定晚年识字是否改善海马测量的情景记忆 功能和结构连接。尽管在研究中招募文盲成年人面临着历史性的挑战， 我们设计了一个成功的策略，达到了目标招募，并获得了基线结构和功能 核磁共振成像，证明我们的方法的可行性。该提案将建立并扩大以下机构之间的合作： UFMG和UCSF实施一项两组随机对照试验，调查成人教育的作用 改善情景记忆和增强海马连接。这种合作关系代表了一种独特的 鉴于两个中心的专业知识和资源相结合，有机会检验这一假设。如果成功 在显示成人教育对记忆、大脑结构和功能的好处时，这项建议将是至关重要的， 制定战略，以提高大脑的弹性，并随后降低痴呆症的风险，使用低成本的 干预值得注意的是，该提案还将通过以下方式促进巴西可持续研究能力的建设： 将先进的纵向神经影像学分析知识传授给UFMG。学到的技术 将应用于不仅在UFMG而且在其他巴西人中进行的关于神经系统疾病的进一步研究。 机构职能体系

Abstract Dementia is epidemic with a projected cost of $1.2 trillion by 2050. Currently, 2/3 of people with dementia live in low and middle-income countries (LMIC). 30% of dementia cases are preventable by modifying risk factors such as low education. Formal education acquired early in life protects against dementia, but whether acquiring education later in life can decrease dementia risk is less clear. Our previous cross-sectional work conducted in Brazil/UFMG in partnership with the USA/UCSF suggests that even few years of education might improve brain resilience by strengthening the relationship between episodic memory and medial temporal lobe structures, including the hippocampus (HC) and its connections. Whether acquiring education in adulthood could also strengthen those relationships and increase hippocampal efficiency is unknown. We started a pilot one-arm longitudinal study to determine whether a late-life literacy improves episodic memory measured by hippocampal functional and structural connectivity. Despite the historical challenges of enrolling illiterate adults in research, we devised a successful strategy and met the target enrollment and acquired baseline structural and functional MRIs, demonstrating feasibility of our approach. This proposal will build on and expand the collaboration between UFMG and UCSF to implement a two-arm, randomized controlled trial investigating the role of adult education in improving episodic memory and enhancing hippocampal connectivity. This partnership represents a unique opportunity to test this hypothesis given the combined expertise and resources from both centers. If successful in showing a benefit of adult education into memory, brain structure and function, this proposal will be critical for developing strategies to improve brain resilience and subsequently decrease dementia risk using a low-cost intervention. Noteworthy, The proposal will also contribute to build sustainable research capacity in Brazil by transferring the knowledge on advanced longitudinal neuroimaging analysis to UFMG. The learned techniques will be applied in further studies about neurological conditions conducted not only in UFMG but other Brazilian institutions.