BACKGROUND: Highly educated participants with normal cognition show lower incidence of Alzheimer's disease (AD) than poorly educated participants, whereas longitudinal studies involving AD have reported that higher education is associated with more rapid cognitive decline. We aimed to evaluate whether highly educated amnestic mild cognitive impairment (aMCI) participants show more rapid cognitive decline than those with lower levels of education. METHODS: A total of 249 aMCI patients enrolled from 31 memory clinics using the standard assessment and diagnostic processes were followed with neuropsychological evaluation (duration 17.2 ± 8.8 months). According to baseline performances on memory tests, participants were divided into early-stage aMCI (-1.5 to -1.0 standard deviation (SD)) and late-stage aMCI (below -1.5 SD) groups. Risk of AD conversion and changes in neuropsychological performances according to the level of education were evaluated. RESULTS: Sixty-two patients converted to AD over a mean follow-up of 1.43 years. The risk of AD conversion was higher in late-stage aMCI than early-stage aMCI. Cox proportional hazard models showed that aMCI participants, and late-stage aMCI participants in particular, with higher levels of education had a higher risk of AD conversion than those with lower levels of education. Late-stage aMCI participants with higher education showed faster cognitive decline in language, memory, and Clinical Dementia Rating Sum of Boxes (CDR-SOB) scores. On the contrary, early-stage aMCI participants with higher education showed slower cognitive decline in MMSE and CDR-SOB scores. CONCLUSIONS: Our findings suggest that the protective effects of education against cognitive decline remain in early-stage aMCI and disappear in late-stage aMCI.
BACKGROUND: Highly educated participants with normal cognition show lower incidence of Alzheimer's disease (AD) than poorly educated participants, whereas longitudinal studies involving AD have reported that higher education is associated with more rapid cognitive decline. We aimed to evaluate whether highly educated amnestic mild cognitive impairment (aMCI) participants show more rapid cognitive decline than those with lower levels of education. METHODS: A total of 249 aMCIpatients enrolled from 31 memory clinics using the standard assessment and diagnostic processes were followed with neuropsychological evaluation (duration 17.2 ± 8.8 months). According to baseline performances on memory tests, participants were divided into early-stage aMCI (-1.5 to -1.0 standard deviation (SD)) and late-stage aMCI (below -1.5 SD) groups. Risk of AD conversion and changes in neuropsychological performances according to the level of education were evaluated. RESULTS: Sixty-two patients converted to AD over a mean follow-up of 1.43 years. The risk of AD conversion was higher in late-stage aMCI than early-stage aMCI. Cox proportional hazard models showed that aMCIparticipants, and late-stage aMCIparticipants in particular, with higher levels of education had a higher risk of AD conversion than those with lower levels of education. Late-stage aMCIparticipants with higher education showed faster cognitive decline in language, memory, and Clinical Dementia Rating Sum of Boxes (CDR-SOB) scores. On the contrary, early-stage aMCIparticipants with higher education showed slower cognitive decline in MMSE and CDR-SOB scores. CONCLUSIONS: Our findings suggest that the protective effects of education against cognitive decline remain in early-stage aMCI and disappear in late-stage aMCI.
Authors: Hyemin Jang; Hee Jin Kim; Seongbeom Park; Yu Hyun Park; Yeongsim Choe; Hanna Cho; Chul Hyoung Lyoo; Uicheul Yoon; Jin San Lee; Yeshin Kim; Seung Joo Kim; Jun Pyo Kim; Young Hee Jung; Young Hoon Ryu; Jae Yong Choi; Seung Hwan Moon; Joon-Kyung Seong; Charles DeCarli; Michael W Weiner; Samuel N Lockhart; Soo Hyun Cho; Duk L Na; Sang Won Seo Journal: Eur J Nucl Med Mol Imaging Date: 2019-08-31 Impact factor: 9.236
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Authors: Dan Mungas; Evan Fletcher; Brandon E Gavett; Keith Widaman; Laura B Zahodne; Timothy J Hohman; Elizabeth Rose Mayeda; N Maritza Dowling; David K Johnson; Sarah Tomaszewski Farias Journal: J Int Neuropsychol Soc Date: 2021-01-18 Impact factor: 2.892