Leonie Beyer1, Johanna Meyer-Wilmes1, Sonja Schönecker2, Jonas Schnabel1, Julia Sauerbeck1, Maximilian Scheifele1, Catharina Prix2, Marcus Unterrainer3, Cihan Catak4, Oliver Pogarell5, Carla Palleis6, Robert Perneczky7, Adrian Danek2, Katharina Buerger8, Peter Bartenstein9, Johannes Levin6, Axel Rominger10, Michael Ewers11, Matthias Brendel12. 1. Dept. of Nuclear Medicine, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany. 2. Dept. of Neurology, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany. 3. Dept. of Nuclear Medicine, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany; Department of Radiology, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany. 4. Institute for Stroke and Dementia Research, University Hospital, Ludwig-Maximilians-Universität München, Feodor-Lynen-Str. 17, 81377 Munich, Germany. 5. Dept. of Psychiatry, University Hospital, Ludwig-Maximilians-Universität München, Nußbaumstr. 7, 80336 Munich, Germany. 6. Dept. of Neurology, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany; DZNE - German Center for Neurodegenerative Diseases, Feodor-Lynen-Str. 17, 81377 Munich, Germany. 7. Dept. of Psychiatry, University Hospital, Ludwig-Maximilians-Universität München, Nußbaumstr. 7, 80336 Munich, Germany; DZNE - German Center for Neurodegenerative Diseases, Feodor-Lynen-Str. 17, 81377 Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Feodor-Lynen-Str. 17, 81377 Munich, Germany; Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College, Level 2, Faculty Building, South Kensington Campus, London SW7 2AZ, United Kingdom. 8. Institute for Stroke and Dementia Research, University Hospital, Ludwig-Maximilians-Universität München, Feodor-Lynen-Str. 17, 81377 Munich, Germany; DZNE - German Center for Neurodegenerative Diseases, Feodor-Lynen-Str. 17, 81377 Munich, Germany. 9. Dept. of Nuclear Medicine, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Feodor-Lynen-Str. 17, 81377 Munich, Germany. 10. Dept. of Nuclear Medicine, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Feodor-Lynen-Str. 17, 81377 Munich, Germany; Dept. of Nuclear Medicine, University of Bern, Inselspital, Freiburgstr. 18, 3010 Bern, Switzerland. 11. DZNE - German Center for Neurodegenerative Diseases, Feodor-Lynen-Str. 17, 81377 Munich, Germany. 12. Dept. of Nuclear Medicine, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Feodor-Lynen-Str. 17, 81377 Munich, Germany. Electronic address: matthias.brendel@med.uni-muenchen.de.
Abstract
BACKGROUND AND OBJECTIVE: Reserve is defined as the ability to maintain cognitive functions relatively well at a given level of pathology. Early life experiences such as education are associated with lower dementia risk in general. However, whether more years of education guards against the impact of brain alterations also in frontotemporal dementia (FTD) has not been shown in a large patient collective. Therefore, we assessed whether education is associated with relatively high cognitive performance despite the presence of [18F]-fluorodeoxyglucose positron-emission-tomography (FDG-PET) hypometabolism in FTD. METHODS: Sixty-six FTD subjects (age 67 ± 8 years) and twenty-four cognitively healthy controls (HC) were evaluated. Brain regions with FTD-related glucose hypometabolism in the contrast against HC and brain regions that correlate with the cognitive function were defined by a voxel-based analysis and individual FDG-PET values were extracted from all frontotemporal brain areas. Linear regression analysis served to test if education is associated with residualized cognitive performance and regional FDG-PET hypometabolism after controlling for global cognition. RESULTS: Compared to healthy controls, patients with FTD showed glucose hypometabolism in bilateral frontal and temporal brain areas whereas cognition was only associated with deteriorated glucose metabolism in the left temporal lobe. The education level was significantly correlated with the residualized cognitive performance (residuals from regression analysis between hypometabolism and cognitive function as a quantitative index of reserve) and also negatively correlated with left temporal FDG-PET hypometabolism after controlling for cognition. CONCLUSIONS: In patients with FTD, the education level predicts the existing left temporal FDG-PET hypometabolism at the same cognition level, supporting the cognitive reserve hypothesis in FTD.
BACKGROUND AND OBJECTIVE: Reserve is defined as the ability to maintain cognitive functions relatively well at a given level of pathology. Early life experiences such as education are associated with lower dementia risk in general. However, whether more years of education guards against the impact of brain alterations also in frontotemporal dementia (FTD) has not been shown in a large patient collective. Therefore, we assessed whether education is associated with relatively high cognitive performance despite the presence of [18F]-fluorodeoxyglucose positron-emission-tomography (FDG-PET) hypometabolism in FTD. METHODS: Sixty-six FTD subjects (age 67 ± 8 years) and twenty-four cognitively healthy controls (HC) were evaluated. Brain regions with FTD-related glucose hypometabolism in the contrast against HC and brain regions that correlate with the cognitive function were defined by a voxel-based analysis and individual FDG-PET values were extracted from all frontotemporal brain areas. Linear regression analysis served to test if education is associated with residualized cognitive performance and regional FDG-PET hypometabolism after controlling for global cognition. RESULTS: Compared to healthy controls, patients with FTD showed glucose hypometabolism in bilateral frontal and temporal brain areas whereas cognition was only associated with deteriorated glucose metabolism in the left temporal lobe. The education level was significantly correlated with the residualized cognitive performance (residuals from regression analysis between hypometabolism and cognitive function as a quantitative index of reserve) and also negatively correlated with left temporal FDG-PET hypometabolism after controlling for cognition. CONCLUSIONS: In patients with FTD, the education level predicts the existing left temporal FDG-PET hypometabolism at the same cognition level, supporting the cognitive reserve hypothesis in FTD.
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