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Association of Education and Intracranial Volume with Cognitive Trajectories and Mortality Rates Across the Alzheimer Disease Continuum

Van Loenhoud, Anna C. ; Groot, Colin LU ; Bocancea, Diana I. ; Barkhof, Frederik ; Teunissen, Charlotte ; Scheltens, Philip ; Van De Flier, Wiesje M. and Ossenkoppele, Rik LU (2022) In Neurology 98(16). p.1679-1691
Abstract

Objective: To investigate relationships of education and intracranial volume (ICV) (factors related to cognitive and brain reserve, respectively) with cognitive trajectories and mortality in individuals with biomarker-defined Alzheimer disease (AD).MethodsWe selected 1,298 β-amyloid-positive memory clinic patients with subjective cognitive decline (SCD, n = 142), mild cognitive impairment (MCI, n = 274), or AD dementia (n = 882) from the Amsterdam Dementia Cohort. All participants underwent baseline MRI and neuropsychological assessment, and 68% received cognitive follow-up (median 2.3 years, interquartile range 2.4). Mortality data were collected from the Central Public Administration. In the total sample and stratified by disease... (More)

Objective: To investigate relationships of education and intracranial volume (ICV) (factors related to cognitive and brain reserve, respectively) with cognitive trajectories and mortality in individuals with biomarker-defined Alzheimer disease (AD).MethodsWe selected 1,298 β-amyloid-positive memory clinic patients with subjective cognitive decline (SCD, n = 142), mild cognitive impairment (MCI, n = 274), or AD dementia (n = 882) from the Amsterdam Dementia Cohort. All participants underwent baseline MRI and neuropsychological assessment, and 68% received cognitive follow-up (median 2.3 years, interquartile range 2.4). Mortality data were collected from the Central Public Administration. In the total sample and stratified by disease stage (i.e., SCD/MCI vs dementia), we examined education and ICV as predictors of baseline and longitudinal cognitive performance on 5 cognitive domains (memory, attention, executive, language, and visuospatial functions; linear mixed models) and time to death (Cox proportional hazard models). Analyses were adjusted for age, sex, whole brain gray matter atrophy, and MRI field strength.ResultsEducation and ICV showed consistent positive associations with baseline cognition across disease stages. Longitudinally, we observed a relationship between higher education and faster cognitive decline among patients with dementia on global cognition, memory, executive function, and language (range β = -0.06 to -0.13; all p < 0.05). Furthermore, in the total sample, both higher education and larger ICV were related to lower mortality risk (hazard ratio 0.84 and 0.82, respectively; p < 0.05).DiscussionIn this β-amyloid-positive memory clinic sample, both cognitive and brain reserve were positively associated with baseline cognition, whereas only education was related to longitudinal cognition (i.e., accelerated decline among more highly educated patients with dementia). Higher education and ICV both moderately attenuated overall mortality risk in AD.

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author
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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Neurology
volume
98
issue
16
pages
1679 - 1691
publisher
Lippincott Williams & Wilkins
external identifiers
  • scopus:85128797035
  • pmid:35314498
ISSN
0028-3878
DOI
10.1212/WNL.0000000000200116
language
English
LU publication?
yes
id
7072d42f-45c3-43aa-a6a9-25aac355b8c5
date added to LUP
2022-07-01 15:20:30
date last changed
2024-06-14 20:41:27
@article{7072d42f-45c3-43aa-a6a9-25aac355b8c5,
  abstract     = {{<p>Objective: To investigate relationships of education and intracranial volume (ICV) (factors related to cognitive and brain reserve, respectively) with cognitive trajectories and mortality in individuals with biomarker-defined Alzheimer disease (AD).MethodsWe selected 1,298 β-amyloid-positive memory clinic patients with subjective cognitive decline (SCD, n = 142), mild cognitive impairment (MCI, n = 274), or AD dementia (n = 882) from the Amsterdam Dementia Cohort. All participants underwent baseline MRI and neuropsychological assessment, and 68% received cognitive follow-up (median 2.3 years, interquartile range 2.4). Mortality data were collected from the Central Public Administration. In the total sample and stratified by disease stage (i.e., SCD/MCI vs dementia), we examined education and ICV as predictors of baseline and longitudinal cognitive performance on 5 cognitive domains (memory, attention, executive, language, and visuospatial functions; linear mixed models) and time to death (Cox proportional hazard models). Analyses were adjusted for age, sex, whole brain gray matter atrophy, and MRI field strength.ResultsEducation and ICV showed consistent positive associations with baseline cognition across disease stages. Longitudinally, we observed a relationship between higher education and faster cognitive decline among patients with dementia on global cognition, memory, executive function, and language (range β = -0.06 to -0.13; all p &lt; 0.05). Furthermore, in the total sample, both higher education and larger ICV were related to lower mortality risk (hazard ratio 0.84 and 0.82, respectively; p &lt; 0.05).DiscussionIn this β-amyloid-positive memory clinic sample, both cognitive and brain reserve were positively associated with baseline cognition, whereas only education was related to longitudinal cognition (i.e., accelerated decline among more highly educated patients with dementia). Higher education and ICV both moderately attenuated overall mortality risk in AD. </p>}},
  author       = {{Van Loenhoud, Anna C. and Groot, Colin and Bocancea, Diana I. and Barkhof, Frederik and Teunissen, Charlotte and Scheltens, Philip and Van De Flier, Wiesje M. and Ossenkoppele, Rik}},
  issn         = {{0028-3878}},
  language     = {{eng}},
  number       = {{16}},
  pages        = {{1679--1691}},
  publisher    = {{Lippincott Williams & Wilkins}},
  series       = {{Neurology}},
  title        = {{Association of Education and Intracranial Volume with Cognitive Trajectories and Mortality Rates Across the Alzheimer Disease Continuum}},
  url          = {{http://dx.doi.org/10.1212/WNL.0000000000200116}},
  doi          = {{10.1212/WNL.0000000000200116}},
  volume       = {{98}},
  year         = {{2022}},
}