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Education reduces cognitive dysfunction in Alzheimer’s disease by changing regional cerebral perfusion: An in-vivo arterial spin labeling study

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Abstract

Objective

Formal education and other cognitive challenges influence brain structure and improve function. It is believed that cognitive activities create a cognitive reserve (CR) that can slow the decline due to aging and neurodegenerative diseases. This study investigated alterations of regional cerebral blood flow (rCBF) associated with high and low CR in different stages of Alzheimer’s disease (AD) and examined whether rCBF alteration mediates the relationship between education and cognitive performance.

Methods

Patients with AD or amnestic mild cognitive impairment (aMCI) and healthy controls were divided into low cognitive reserve (LCR) and high cognitive reserve (HCR) subgroups according to median of education years (≤ 9 vs. > 9 years). The final study population included 89 AD patients (67 LCR, 22 HCR), 74 aMCI patients (44 LCR, 30 HCR), and 66 healthy controls (29 LCR, 37 HCR). All subjects were examined by arterial spin labeling magnetic resonance imaging and a neurocognitive test battery. rCBF was compared among groups by two-way analysis of variance. Mediation analyses were used to explore the relationships among education, rCBF, and cognitive test scores.

Results

There were significant interaction effects of disease state (AD, aMCI, HC) and education level (LCR, HCR) on CBF in right hippocampus, posterior cingulate cortex, and right inferior parietal cortex (R_IPC). Education regulated episodic memory score by influencing right hippocampal CBF in HC_HCR and aMCI_HCR subgroups.

Conclusion

Our results indicate that the protective effect of education against cognitive dysfunction in early-stage AD is mediated at least partially by altered CBF in right hippocampus.

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Acknowledgments

This research was supported by the National Natural Science Foundation of China (Fund number: 81901726, 81771817, 82071905). We would like to thank the many collaborators for their work in setting up the study and implementing the protocol. We would like to thank our patients for their role in the research design.

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Author notes

  1. Wanqiu Zhu and Ziwen Gao contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, The First Affiliated Hospital of Anhui Medical University, No. 218, Jixi Road, Shushan District, Hefei, 230022, China

    Wanqiu Zhu, Ziwen Gao, Hui Li, Ziang Huang, Xiaohu Li, Haibao Wang, Xiaoshu Li & Yongqiang Yu

  2. Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China

    Xingqi Wu, Yanghua Tian & Shanshan Zhou

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  1. Wanqiu Zhu
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Contributions

Wanqiu Zhu: Data collection, Methodology, Software, Formal analysis, Validation, Writing - original draft. Ziwen Gao: Data collection, Data curation, Visualization, Investigation, Software. Hui Li: Data collection. Ziang Hang: Data collection. Xiaohu Li: Methodology, Software. Haibao Wang: Methodology, Software. Xingqi Wu: Data collection, Data curation, Visualization, Investigation. Yanghua Tian: Data curation, Visualization, Investigation. Shanshan Zhou: Data curation, Visualization, Investigation. Xiaoshu Li: Methodology, Software, Formal analysis, Funding acquisition, Writing - review & editing. Yongqiang Yu: Conceptualization, Formal analysis, Funding acquisition, Project administration, Resources, Supervision, Writing - review & editing.

Corresponding authors

Correspondence to Xiaoshu Li or Yongqiang Yu.

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This study was approved by the Medical Research Ethics Committee of the First Affiliated Hospital of Anhui Medical University, China, according to the Declaration of Helsinki. Informed consent was provided by all subjects.

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The authors declare no conflict of interest.

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Zhu, W., Gao, Z., Li, H. et al. Education reduces cognitive dysfunction in Alzheimer’s disease by changing regional cerebral perfusion: An in-vivo arterial spin labeling study. Neurol Sci 44, 2349–2361 (2023). https://doi.org/10.1007/s10072-023-06696-x

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