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The effect of education on rCBF changes in Alzheimer’s disease: a longitudinal SPECT study

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

To determine the relationship of differing levels of education on regional cerebral blood flow (rCBF) in patients with Alzheimer’s disease (AD).

Methods

Fifty-three patients with AD followed-up for an average of 36 months were divided into the high-educated group (HE, ≥12 years of schooling) and low-educated group (LE, <12 years of schooling). The cognitive and functional impairment was assessed using the Mini-Mental State Examination (MMSE) and the Functional Assessment Staging (FAST), respectively. Initial and follow-up rCBF were assessed using SPECT with N-isopropyl-p-[123I]-iodoamphetamine and the SPECT data were analyzed by 3D-stereotactic surface projections.

Results

At initial evaluation, the HE group had greater rCBF deficits in the parietotemporal regions than did the LE group, even though both groups had comparable MMSE and FAST scores. When compared with initial SPECT, follow-up SPECT showed a significant rCBF reduction in widespread regions, including the frontal, parietal, temporal, and limbic lobes of the HE group, while it a significant rCBF reduction in scattered and small regions of the parietotemporal, cingulate, and occipital areas of the LE group, as the HE group had faster cognitive and functional decline than the LE group.

Conclusion

The HE group showed lower rCBF at initial SPECT than the LE group, suggesting more advanced AD pathology. As a result, the HE group demonstrated a more extensive and severe reduction of rCBF on follow-up SPECT in association with faster cognitive and functional decline than the LE group. Our SPECT study provides stronger support for the cognitive reserve effects of education in AD.

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References

  1. Stern Y. Cognitive reserve and Alzheimer’s disease. Alzheimer Dis Assoc Disord 2006;20:S69–74.

    Article  PubMed  Google Scholar 

  2. Teri L, McCurry SM, Edland SD, Kukull WA, Larson EB. Cognitive decline in Alzheimer’s disease: a longitudinal investigation of risk factors for accelerated decline. J Gerontol Ser A Biol Sci Med Sci 1995;50A:M49–55.

    CAS  Google Scholar 

  3. Unverzagt FW, Hui SL, Farlow MR, Hall KS, Hendrie HC. Cognitive decline and education in mild dementia. Neurology 1998;50:181–5.

    PubMed  CAS  Google Scholar 

  4. Stern Y, Albert S, Tang M-X, Tsai W-Y. Rate of memory decline in AD is related to education and occupation. Cognitive reserve? Neurology 1999;53:1942–7.

    PubMed  CAS  Google Scholar 

  5. Wilson RS, Li Y, Aggarwal NT, et al. Education and the course of cognitive decline in Alzheimer’s disease. Neurrology 2004;63:1198–202.

    CAS  Google Scholar 

  6. Scarmeas N, Albert SM, Manly JJ, Stern Y. Education and rates of cognitive decline in incident Alzheimer’s disease. J Neurol Neurosurg Psychiatry 2006;77:308–16.

    Article  PubMed  CAS  Google Scholar 

  7. Andel R, Vigen C, Mack WJ, Clark LJ, Gatz M. The effect of education and occupational complexity on rate of cognitive decline in Alzheimer’s patients. J Int Neuropsychol Soc 2006;12:147–52.

    Article  PubMed  Google Scholar 

  8. Bruandet A, Richard F, Bombois S, et al. Cognitive decline and survival in Alzheimer’s disease according to education level. Dement Geriatr Cogn Disord 2008;25:74–80.

    Article  PubMed  CAS  Google Scholar 

  9. Fritsch T, McClendon MJ, Smyth KA, Ogrocki PK. Effects of educational attainment and occupational status on cognitive and functional decline in persons with Alzheimer-type dementia. Int Psychogeriatr 2002;14:347–63.

    Article  PubMed  Google Scholar 

  10. Filley CM, Brownell HH, Albert ML. Education provide no protection against Alzheimer’s disease. Neurology 1985;35:1781–4.

    PubMed  CAS  Google Scholar 

  11. Del Ser T, Hachinski V, Merskey H, Munoz DG. An autopsy-verified study of the effect of education on degenerative dementia. Brain 1999;122:2309–19.

    Article  PubMed  Google Scholar 

  12. Bowler JV, Munoz DG, Merskey H, hachinski V. Factors affecting the age of onset and rate of progression of Alzheimer’s disease. J Neurol Neurosurg Psychiatry 1998;65:184–90.

    Article  PubMed  CAS  Google Scholar 

  13. Suh G-K, Ju Y-S, Yeon BK, Shah A. A longitudinal study of Alzheimer’s disease: rates of cognitive and functional decline. Int J Geriatr Psychiatry 2004;19:817–24.

    Article  PubMed  Google Scholar 

  14. Alexander GE, Furey ML, Grady CL, et al. Association of premorbid intellectual function with cerebral metabolism in Alzheimer’s disease: implications for the cognitive reserve hypothesis. Am J Psychiatry 1997;154:165–72.

    PubMed  CAS  Google Scholar 

  15. Perneczky R, Drzezga A, Diehl-Schmid J, et al. Schooling mediates brain reserve in Alzheimer’s disease: findings of fluoro-deoxy-glucose-positron emission tomography. J Neurol Neurosurg Psychiatry 2006;77:1060–3.

    Article  PubMed  CAS  Google Scholar 

  16. Stern Y, Alexander GE, Prohovnik I, Mayeux R. Inverse relatiohship between education and parietotemporal perfusion deficit in Alzheimer’s disease. Ann Neurol 1992;32:371–5.

    Article  PubMed  CAS  Google Scholar 

  17. Liao Y-C, Liu R-S, Teng EL, et al. Cognitive reserve: a SPECT study of 132 Alzheimer’s disease patients with and education range of 0–19 years. Dement Geriatr Cogn Disord 2005;20:8–14.

    Article  PubMed  Google Scholar 

  18. Scarmeas N, Zarahn E, Anderson KE, et al. Association of life activities with cerebral blood flow in Alzheimer disease. Arch Neurol 2003;60:359–65.

    Article  PubMed  Google Scholar 

  19. Chiu N-T, Lee B-F, Hsiao S, Pai M-C. Educational level influences regional cerebral blood flow in patients with Alzheimer’s disease. J Nucl Med 2004;45:1860–3.

    PubMed  Google Scholar 

  20. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s disease. Neurology 1984;34:939–44.

    PubMed  CAS  Google Scholar 

  21. Highes CP, Berg L, Danzieger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Br J Psychiatry 1982;140:566–72.

    Article  Google Scholar 

  22. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–98.

    Article  PubMed  CAS  Google Scholar 

  23. Reisberg B. Functional assessment staging (FAST). Psychopharmacol Bull 1998;24:653–9.

    Google Scholar 

  24. Bravo G, Hebert R. Age- and education-specific reference values for the mini-mental and modified mini-mental state examinations derived from a non-demented elderly population. Int J Geriatr Psychiatry 1997;12:1008–18.

    Article  PubMed  CAS  Google Scholar 

  25. Anderson TM, Sachdev PS, Brodaty H, Trollor JN, Andrews G. Effects of sociodemographic and health variables on Mini-Mental State Exam scores in older Australians. Am J Geriatr Psychiatry 2007;15:467–76.

    Article  PubMed  Google Scholar 

  26. Minoshima S, Frey KA, Koeppe RA, Foster NL, Kuhl DE. A diagnostic approach in Alzheimer’s disease using three-dimensional stereotactic surface projections of fluorine-18-FDG PET. J Nucl Med 1995;36:1238–48.

    PubMed  CAS  Google Scholar 

  27. Talairach J, Tournoux P. Co-planar stereotactic atlas of the human brain. New York: Thieme; 1998.

    Google Scholar 

  28. Minoshima S, Koeppe RA, Frey KA, Kuhl DE. Anatomic standardization: linear scaling and nonlinear warping of functional brain images. J Nucl Med 1994;35:1528–37.

    PubMed  CAS  Google Scholar 

  29. Mizumura S, Kumita S, Cho K, et al. Development of quantitative analysis method for stereotactic brain image: assessment of reduced accumulation in extent and severity using anatomical segmentation. Ann Nucl Med 2003;17:289–95.

    Article  PubMed  Google Scholar 

  30. Monteiro IM, Boksay I, Auer SR, et al. Reliability of routine clinical instruments for the assessment of Alzheimer’s disease administrated by telephone. J Geriatr Psychiatry Neurol 1998;11:18–24.

    PubMed  CAS  Google Scholar 

  31. Bennett DA, Wilson RS, Schneider JA, et al. Education modifies the relation of AD pathology to level of cognitive function in older persons. Neurology 2003;60:1909–15.

    PubMed  CAS  Google Scholar 

  32. Koepsell TD, Kurland BF, Harel O, Johnson EA, Zhou XH, Kukull WA. Education, cognitive function, and severity of neuropathology in Alzheimer disease. Neurology 2008;70:1732–9.

    Article  PubMed  CAS  Google Scholar 

  33. Hall CB, Derby C, LeValley A, Katz MJ, Verghese J, Lipton RB. Education delays accelerated decline on a memory test in persons who developed dementia. Neurology 2007;69:1657–64.

    Article  PubMed  CAS  Google Scholar 

  34. Mann UM, Mohr E, Gearing M, Chase TN. Heterogeneity in Alzheimer’s disease: progression rate segregated by distinct neuropsychological and cerebral metabolic profiles. J Neurol Neurosurg Psychiatry 1992;55:956–9.

    Article  PubMed  CAS  Google Scholar 

  35. Nishimura T, Hashikawa K, Fukuyama H, Kubota T, Kitamura S, Matsuda H, et al. Decreased cerebral blood flow and prognosis of Alzheimer’s disease: a multicenter HMPAO-SPECT study. Ann Nucl Med 2007;21:15–23.

    PubMed  Google Scholar 

  36. Uhlmann RF, Larson EB. Effect of education on the Mini-Mental State Examination as a screening test for dementia. J Am Geriatr Soc 1991;39:876–80.

    PubMed  CAS  Google Scholar 

  37. O’Connor DW, Pollitt PA, Treasure FP, Brook PB, Reiss BB. The influence of education, social class and sex on Mini-Mental State scores. Psychol Med 1989;19:771–6.

    PubMed  CAS  Google Scholar 

  38. Clark CM, Sheppard L, Fillenbaum GG, et al. Variability in annual Mini-Mental State Examination score in patients with probable Alzheimer disease. Arch Neurol 1999;56:857–62.

    Article  PubMed  CAS  Google Scholar 

  39. Haxby JV, Raffaele K, Gillette J, Schapiro MB, Rapoport SI. Individual trajectories of cognitive decline in patients with dementia of the Alzheimer type. J Clin Exp Neuropsychol 1992;14:575–92.

    Article  PubMed  CAS  Google Scholar 

  40. Winblad B, Wimo A, Engedal K, et al. 3-year study of donepezil therapy in Alzheimer’s disease: effects of early and continuous therapy. Dement Geraitr Cogn Disord 2006;21:353–63.

    Article  CAS  Google Scholar 

  41. Doraiswamy PM, Leon J, Cummings JL, Marin D, Neumann PJ. Prevalence and impact of medical comorbidity in Alzheimer’s disease. J Gerontol Ser A Biol Sci Med Sci 2002;57:M173–177.

    Google Scholar 

  42. Boksay I, Boksay E, Reisberg B, Torossaian C, Krishnamurthy M. Alzheimer’s disease and medical disease conditions: a prospective cohort study. J Am Geriatr Soc 2005;53:2235–6.

    Article  PubMed  Google Scholar 

  43. Karp A, Kareholt I, Qiu C, et al. Relation of education and occupation-based socioeconomic status to incident Alzheimer’s disease. Am J Epidemiol 2004;159:175–83.

    Article  PubMed  Google Scholar 

  44. Fratiglioni L, Paillard-Borg S, Winblad B. An active and socially integrated lifestyle in late life might protect against dementia. Lancet Neurol 2004;3:342–53.

    Article  Google Scholar 

  45. Ishii K, Willoch F, Minoshima S, et al. Statistical brain mapping of 18F-FDG PET in Alzheimer’s disease: validation of anatomic standardization for atrophied brains. J Nucl Med 2001;42:548–57.

    PubMed  CAS  Google Scholar 

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Acknowledgements

We thank K. Hirayama and H. Hirose of the Department of Nuclear Medicine of Tokyo Medical University for their support and technical assistance. We are also grateful to Professor J. Patrick Barron of the International Medical Communications Center of Tokyo Medical University for his review of the manuscript.

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Authors and Affiliations

  1. Department of Geriatric Medicine, Tokyo Medical University, 6-7-1 Nishishinjuku Shinjuku-ku, Tokyo, 160-0023, Japan

    Haruo Hanyu, Tomohiko Sato, Soichiro Shimizu, Hidekazu Kanetaka & Toshihiko Iwamoto

  2. Department of Radiology, Tokyo Medical University, Tokyo, Japan

    Kiyoshi Koizumi

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  1. Haruo Hanyu
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  2. Tomohiko Sato
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  3. Soichiro Shimizu
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  4. Hidekazu Kanetaka
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Correspondence to Haruo Hanyu.

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Hanyu, H., Sato, T., Shimizu, S. et al. The effect of education on rCBF changes in Alzheimer’s disease: a longitudinal SPECT study. Eur J Nucl Med Mol Imaging 35, 2182–2190 (2008). https://doi.org/10.1007/s00259-008-0848-4

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  • DOI: https://doi.org/10.1007/s00259-008-0848-4

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