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Discrepancy Between the Degree of Cognitive Impairment and Brain Imaging Abnormalities in Alzheimer’s Disease Patients Is Associated with Cognitive Reserve
Journal of Alzheimer’s Disease ( IF 4 ) Pub Date : 2021-09-10 , DOI: 10.3233/jad-210728
Tomohiko Sato 1 , Haruo Hanyu 1, 2 , Yumi Koyama 3 , Haruka Horita 3 , Toshinori Aoki 4 , Kentaro Hirao 1 , Hidekazu Kanetaka 1 , Soichiro Shimizu 1
Affiliation  

Background:In Alzheimer’s disease (AD) patients, the severity of cognitive impairment is thought to correlate with the degree of brain imaging abnormalities. However, some patients show only mild cognitive deficit, despite severe brain atrophy on magnetic resonance imaging (MRI) or marked hypoperfusion in the cerebral cortices on single-photon emission computed tomography (SPECT). This suggests that cognitive reserve (CR) can compensate for the clinical manifestations of AD in patients with extensive brain pathology. Objective:We aimed to determine whether this discrepancy between cognitive and imaging findings is associated with CR. Methods:Factors associated with the discrepancy between the degree of cognitive impairment and MRI (medial temporal lobe atrophy) and SPECT (posterior cerebral hypoperfusion) findings were analyzed in 135 patients with probable AD. Factors as proxies for CR included education, occupation, leisure activity, comorbidities, frailty, and other demographics. The discrepancy index (DI) was calculated as the difference between the degree of imaging abnormalities and the degree of cognitive dysfunction. Results:Multiple regression analysis showed that leisure activity and education were significantly associated with the discrepancy between cognitive and imaging findings. When the level of CR was determined based on leisure activity and education, the high-CR group showed a significantly larger DI than the moderate- and low-CR groups. Conclusion:The discrepancy between cognitive and imaging findings in patients with AD is associated with CR, measured using a combination of two indicators, i.e., leisure activity and education. Therefore, lifestyle interventions may delay the appearance of clinical symptoms resulting from underlying AD pathology, by increasing CR.

中文翻译:

阿尔茨海默病患者认知障碍程度与脑成像异常的差异与认知储备有关

背景:在阿尔茨海默病 (AD) 患者中,认知障碍的严重程度被认为与脑成像异常的程度相关。然而,尽管磁共振成像 (MRI) 显示严重的脑萎缩或单光子发射计算机断层扫描 (SPECT) 显示大脑皮质显着低灌注,但一些患者仅表现出轻度认知缺陷。这表明认知储备(CR)可以补偿具有广泛脑病理的患者的 AD 临床表现。目的:我们旨在确定认知和影像学发现之间的这种差异是否与 CR 相关。方法:在 135 名可能患有 AD 的患者中分析了与认知障碍程度与 MRI(内侧颞叶萎缩)和 SPECT(后脑灌注不足)结果之间差异的相关因素。作为 CR 的替代因素包括教育、职业、休闲活动、合并症、虚弱和其他人口统计数据。差异指数 (DI) 计算为影像异常程度与认知功能障碍程度之间的差异。结果:多元回归分析显示休闲活动和教育与认知和影像学发现之间的差异显着相关。当根据休闲活动和教育确定 CR 水平时,高 CR 组的 DI 显着高于中低 CR 组。结论:AD 患者的认知和影像学发现之间的差异与 CR 相关,使用两个指标的组合来衡量,即休闲活动和教育。因此,生活方式干预可以通过增加 CR 来延迟由潜在 AD 病理引起的临床症状的出现。
更新日期:2021-09-15
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