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

摘要 痴呆症很流行，预计到2050年，痴呆症的成本将达到1.2万亿美元。目前，三分之二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修改以下危险因素来预防 因为受教育程度低。在生命早期获得的正规教育可以预防痴呆症，但 晚年的教育能否降低患痴呆症的风险还不是很清楚。我们之前的横断面工作是在 巴西/UFMG与美国/加州大学旧金山分校的合作表明，即使是几年的教育也可能改善大脑 通过加强情节记忆和内侧颞叶结构之间的关系来恢复能力， 包括海马体(HC)及其连接。成年后接受教育是否也可以 加强这些关系并提高海马区的效率是未知的。我们开始了单臂飞行 用海马体测量确定晚年识字是否能改善情节记忆的纵向研究 功能联通和结构联通。尽管让文盲成人参与研究面临着历史上的挑战， 我们制定了成功的战略，达到了目标招生人数，并获得了基线结构和功能 核磁共振成像，证明了我们方法的可行性。这项提议将建立并扩大两国之间的合作 UFMG和UCSF将实施一项双臂随机对照试验，调查成人教育的作用 改善情节记忆和增强海马区连通性。这一伙伴关系代表着一种独特的 在两个中心的专业知识和资源相结合的情况下，有机会检验这一假设。如果成功 在展示成人教育对记忆、大脑结构和功能的好处方面，这项建议将对 开发战略，以提高大脑的弹性，并随后降低痴呆症的风险使用低成本 干预。值得注意的是，该提案还将有助于通过以下方式在巴西建立可持续的研究能力 将先进的纵向神经影像分析知识传授给UFMG。学到的技巧 将应用于不仅在UFMG，而且在其他巴西人进行的关于神经疾病的进一步研究 机构。

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.