Marion Mortamais1, Florence Portet2, Adam M Brickman3, Frank A Provenzano3, Jordan Muraskin3, Tasnime N Akbaraly4, Claudine Berr1, Jacques Touchon1, Alain Bonafé5, Emmanuelle le Bars5, Nicolas Menjot de Champfleur5, Jerome J Maller6, Chantal Meslin7, Robert Sabatier8, Karen Ritchie9, Sylvaine Artero10. 1. Inserm, U1061, La Colombière Hospital, Montpellier, France; University of Montpellier 1, Montpellier, France. 2. Inserm, U1061, La Colombière Hospital, Montpellier, France; Montpellier University Hospital, University Department of Adult Psychiatry, La Colombière Hospital, CHU de Montpellier, Montpellier, France. 3. Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, NY. 4. Inserm, U1061, La Colombière Hospital, Montpellier, France; University of Montpellier 1, Montpellier, France; Department of Epidemiology and Public Health, University College London, United Kingdom. 5. University of Montpellier 1, Montpellier, France; CHRU Montpellier, Montpellier, France. 6. Monash Alfred Psychiatry Research Centre, The Alfred & Monash University Central Clinical School, Melbourne, Australia. 7. Centre for Mental Health Research, Australian National University, Canberra, Australia. 8. University of Montpellier 1, Montpellier, France. 9. Inserm, U1061, La Colombière Hospital, Montpellier, France; University of Montpellier 1, Montpellier, France; Faculty of Medicine, Imperial College, St Mary's Hospital, London, United Kingdom. 10. Inserm, U1061, La Colombière Hospital, Montpellier, France; University of Montpellier 1, Montpellier, France. Electronic address: sylvaine.artero@inserm.fr.
Abstract
OBJECTIVES: Conflicting results have been reported regarding the association between white matter lesions (WML) and cognitive impairment. We hypothesized that education, a marker of cognitive reserve (CR), could modulate the effects of WML on the risk of mild cognitive impairment (MCI) or dementia. METHODS: We followed 500 healthy subjects from a cohort of community-dwelling persons aged 65 years and over (ESPRIT Project). At baseline, WML volume was measured using a semi-automatic method on T2-weighted MRI. Standardized cognitive and neurological evaluations were repeated after 2, 4, and 7 years. The sample was dichotomized according to education level into low (≤8 years) and high (>8 years) education groups. Cox proportional hazard models were constructed to study the association between WML and risk of MCI/dementia. RESULTS: The interaction between education level and WML volume reached significance (p = 0.017). After adjustment for potential confounders, the association between severe WML and increased MCI/dementia risk was significant in the low education group (≤8 years) (p = 0.02, hazard ratio [HR]: 3.77 [1.29-10.99]), but not in the high education group (>8 years) (p = 0.82, HR: 1.07 [0.61-1.87]). CONCLUSIONS: Severe WML significantly increases the risk of developing MCI/dementia over a 7-year period in low educated participants. Subjects with higher education levels were seen to be more likely to be resilient to the deleterious effects of severe WML. The CR hypothesis suggests several avenues for dementia prevention.
OBJECTIVES: Conflicting results have been reported regarding the association between white matter lesions (WML) and cognitive impairment. We hypothesized that education, a marker of cognitive reserve (CR), could modulate the effects of WML on the risk of mild cognitive impairment (MCI) or dementia. METHODS: We followed 500 healthy subjects from a cohort of community-dwelling persons aged 65 years and over (ESPRIT Project). At baseline, WML volume was measured using a semi-automatic method on T2-weighted MRI. Standardized cognitive and neurological evaluations were repeated after 2, 4, and 7 years. The sample was dichotomized according to education level into low (≤8 years) and high (>8 years) education groups. Cox proportional hazard models were constructed to study the association between WML and risk of MCI/dementia. RESULTS: The interaction between education level and WML volume reached significance (p = 0.017). After adjustment for potential confounders, the association between severe WML and increased MCI/dementia risk was significant in the low education group (≤8 years) (p = 0.02, hazard ratio [HR]: 3.77 [1.29-10.99]), but not in the high education group (>8 years) (p = 0.82, HR: 1.07 [0.61-1.87]). CONCLUSIONS: Severe WML significantly increases the risk of developing MCI/dementia over a 7-year period in low educated participants. Subjects with higher education levels were seen to be more likely to be resilient to the deleterious effects of severe WML. The CR hypothesis suggests several avenues for dementia prevention.
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