We analyzed education, as a proxy of cognitive reserve, and the cholinergic pathway in Alzheimer's disease (AD), to test the hypothesis that education might modulate the relationship between clinical symptoms and metabolic and structural changes in AD. We included 84 subjects and compared between diagnostic groups and different educational levels the glucose metabolism of basal forebrain (BFM) and volume of the basal forebrain, the major cholinergic structure, and hippocampus (HM) (and hippocampal volume), a relevant projection site for the basal forebrain. Correlations with the global cognitive status and education in the whole sample were also performed. Patients with AD dementia showed reduced basal forebrain volume, hippocampal volume, and HM compared with controls. In the whole group, the global cognitive status was positively correlated with BFM and HM. Among high-educated subjects, mild cognitive impairment showed higher BFM and HM in comparison to other diagnostic groups. Our results suggest that in mild cognitive impairment subjects with a higher educational level, cholinergic activity is upregulated and this appears to have a compensatory effect, which may be lost in later symptomatic stages.

中文翻译：

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阿尔茨海默病连续体中的基础前脑代谢：与教育的关系

我们分析了作为认知储备代理的教育和阿尔茨海默病 (AD) 的胆碱能通路，以检验教育可能调节 AD 的临床症状与代谢和结构变化之间关系的假设。我们纳入了 84 名受试者，并在诊断组和不同教育水平之间比较了基底前脑 (BFM) 的葡萄糖代谢和基底前脑的体积、主要胆碱能结构和海马 (HM)（和海马体积），这是基底前脑。还进行了与整个样本中的全球认知状态和教育的相关性。与对照组相比，AD 痴呆患者的基础前脑体积、海马体积和 HM 减少。在整个团体中，整体认知状态与 BFM 和 HM 呈正相关。在受过高等教育的受试者中，与其他诊断组相比，轻度认知障碍显示出更高的 BFM 和 HM。我们的结果表明，在具有较高教育水平的轻度认知障碍受试者中，胆碱能活性上调，这似乎具有补偿作用，可能会在以后的症状阶段消失。