Alzheimer's, Dementia & Mental Health
Better Educated Cope Best as Mild Cognitive
Impairment Advances to Alzheimer’s
Study supports employing the brain in complex tasks
may help form stronger ‘defenses’ against cognitive deterioration when
June 4, 2013 - Highly educated individuals with
mild cognitive impairment that later progressed to Alzheimer’s disease
coped better with the disease than individuals with a lower level of
education in the same situation, according to research published in the
June issue of The Journal of Nuclear Medicine.
In the study, neural reserve and neural
compensation were both shown to play a role in determining cognitive
reserve, as evidenced by positron emission tomography (PET).
Cognitive reserve refers to the hypothesized
capacity of an adult brain to cope with brain damage in order to
maintain a relatively preserved functional level. Understanding the
brain adaptation mechanisms underlying this process remains a critical
question, and researchers sought to investigate the metabolic basis of
cognitive reserve in individuals with higher (more than 12 years) and
lower (less than 12 years) levels of education who had mild cognitive
impairment that progressed to Alzheimer’s disease, also known as
prodromal Alzheimer’s disease.
“This study provides new insight into the
functional mechanisms that mediate the cognitive reserve phenomenon in
the early stages of Alzheimer’s disease,” said Silvia Morbelli, MD, lead
author of the study.
“A crucial role of the dorso-lateral prefrontal
cortex was highlighted by demonstrating that this region is involved in
a wide fronto-temporal and limbic functional network in patients with
Alzheimer’s disease and high education, but not in poorly educated
Alzheimer’s disease patients.”
In the study, 64 patients with prodromal
Alzheimer’s disease and 90 control subjects - coming from the brain PET
project (chaired by Flavio Nobili, MD, in Genoa, Italy) of the European
Alzheimer Disease Consortium – underwent brain
Individuals were divided into a subgroup with a low
level of education (42 controls and 36 prodromal Alzheimer’s disease
patients) and a highly educated subgroup (40 controls and 28 prodromal
Alzheimer’s disease patients). Brain metabolism was compared between
education-matched groups of patients and controls, and then between
highly and poorly educated prodromal Alzheimer’s disease patients.
Higher metabolic activity was shown in the
dorso-lateral prefrontal cortex for prodromal Alzheimer’s disease
patients. More extended and significant correlations of metabolism
within the right dorso-lateral prefrontal cortex and other brain regions
were found with highly educated than less educated prodromal Alzheimer’s
disease patients or even highly educated controls.
This result suggests that neural reserve and neural
compensation are activated in highly educated prodromal Alzheimer’s
disease patients. Researchers concluded that evaluation of the
implication of metabolic connectivity in cognitive reserve further
confirms that adding a comprehensive evaluation of resting
PET brain distribution to standard inspection may allow a more complete
comprehension of Alzheimer’s disease pathophysiology and possibly may
18F-FDG PET diagnostic sensitivity.
“This work supports the notion that employing the
brain in complex tasks and developing our own education may help in
forming stronger ‘defenses’ against cognitive deterioration once
Alzheimer knocks at our door,” noted Morbelli. “It’s possible that, in
the future, a combined approach evaluating resting metabolic
connectivity and cognitive performance can be used on an individual
basis to better predict cognitive decline or response to
According to the World Health Organization,
Alzheimer’s disease affects an estimated 18 million people worldwide,
and incidence of the disease is expected to double by the year 2025 to
34 million. The National Institute on Aging estimates that as many as 50
percent of Americans aged 85 or older are affected.
Authors of the article “Metabolic Networks
Underlying Cognitive Reserve in Prodromal Alzheimer Disease: A European
Alzheimer Disease Consortium Project” include Silvia Morbelli, Mehrdad
Naseri and Gianmario Sambuceti, Nuclear Medicine, Department of Internal
Medicine, IRCCS AOU San Martino–IST, University of Genoa, Genoa, Italy;
Robert Perneczky, Department of Psychiatry and Psychotherapy, Technische
Universität, Munich, Germany, and Neuroepidemiology and Ageing Research
Unit, School of Public Health, Faculty of Medicine, Imperial College of
Science, Technology and Medicine, London, United Kingdom; Alexander
Drzezga, Department of Nuclear Medicine, Technische Universität, Munich,
Germany; Giovanni B. Frisoni, LENITEM Laboratory of Epidemiology and
Neuroimaging–IRCCS S. Giovanni di Dio-FBF, Brescia, Italy; Anna Caroli,
LENITEM Laboratory of Epidemiology and Neuroimaging–IRCCS S. Giovanni di
Dio-FBF, Brescia, Italy, and Medical Imaging Unit, Biomedical
Engineering Department, Mario Negri Institute, Bergamo, Italy; Bart N.M.
van Berckel and Rik Ossenkoppele, Department of Nuclear Medicine & PET
Research, VU University Medical Center, Amsterdam, The Netherlands; Eric
Guedj, Aix-Marseille University, CERIMED and CNRS, Marseille, France;
Mira Didic, APHM, CHU Timone, Service de Neurologie et Neuropsychologie,
Aix-Marseille University, INSERM U 1106, Marseille, France; Andrea
Brugnolo and Flavio Nobili, Clinical Neurophysiology, Department of
Neuroscience, Ophthalmology and Genetics, IRCCS AOU San Martino–IST,
University of Genoa, Genoa, Italy; and Marco Pagani, Institute of
Cognitive Sciences and Technologies, CNR, Rome, Italy and Department of
Nuclear Medicine, Karolinska Hospital, Stockholm, Sweden.
The Journal of Nuclear Medicine can be found
About the Society of Nuclear Medicine and
The Society of Nuclear Medicine and Molecular
Imaging (SNMMI) is an international scientific and medical organization
dedicated to raising public awareness about nuclear medicine and
molecular imaging, a vital element of today’s medical practice that adds
an additional dimension to diagnosis, changing the way common and
devastating diseases are understood and treated and helping provide
patients with the best health care possible.
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