Education Attenuates the Effect of Medial Temporal Lobe Atrophy on Cognitive Function in Alzheimer's Disease: The MIRAGE Study

Article type: Research Article

Authors: Perneczky, Robert^{a; *} | Wagenpfeil, Stefan^b | Lunetta, Kathryn L.^c | Cupples, L. Adrienne^c | Green, Robert C.^{d; e} | DeCarli, Charles^f | Farrer, Lindsay A.^{c; d; e} | Kurz, Alexander^a;

Affiliations: [a] Department of Psychiatry and Psychotherapy, Technische Universität München, München, Germany | [b] Institute of Medical Statistics and Epidemiology, Technische Universität München, München, Germany | [c] Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA | [d] Departments of Neurology and Medicine (Genetics Program), Boston University School of Medicine, Boston, Massachusetts, USA | [e] Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA | [f] Department of Neurology, University of California at Davis, California, USA

Correspondence: [*] Corresponding author: Robert Perneczky, MD, Department of Psychiatry and Psychotherapy, Technische Universität München, Ismaninger Str. 22, 81675 München, Germany. Tel.: +49 89 4140 6055; Fax: +49 89 4140 4888; E-mail: robert.perneczky@lrz.tum.de.

Note: [1] For the MIRAGE Study Group. MIRAGE Study Group members are listed in the Acknowledgments.

Note: [] Communicated by Kurt Jellinger

Abstract: Functional imaging and neuropathological studies suggest that individuals with higher education have better cognitive performance at the same level of brain pathology than less educated subjects. No in vivo studies are available that directly test how education modifies the effect of structural pathology on cognition in Alzheimer's disease (AD). The present study therefore aimed to measure this effect using data from a large multi-center study. 270 patients with AD underwent cognitive testing using the Mini Mental State Examination (MMSE), apolipoprotein E (APOE) genotyping, and cerebral magnetic resonance imaging. A linear regression analysis was used to examine the relation of medial temporal lobe atrophy (MTA), as a proxy of AD pathology, to MMSE score, adjusting for age, gender, APOE, cerebrovascular disease, ethnicity, education, and disease duration. An interaction term for MTA and education was introduced to test the hypothesis that education modifies the effect of MTA on cognition. There was a significant inverse association between MTA and cognition. Most interestingly, the interaction term between education and MTA was significant suggesting that education modifies the relation of MTA to cognition. At any level of pathology, cognition remained higher for better educated individuals.

Keywords: Alzheimer's disease, cognition, cognitive reserve, dementia, education, hippocampus, magnetic resonance imaging, medial temporal lobe atrophy

DOI: 10.3233/JAD-2009-1117

Journal: Journal of Alzheimer's Disease, vol. 17, no. 4, pp. 855-862, 2009