Clinical dementia severity associated with ventricular size is differentially moderated by cognitive reserve in men and women

Abstract

BackgroundInterindividual differences in cognitive reserve (CR) are associated with complex and dynamic clinical phenotypes observed in cognitive impairment and dementia. We tested whether (1) CR early in life (E-CR; measured by education and IQ), (2) CR later in life (L-CR; measured by occupation), and (3) CR panel (CR-P) with the additive effects of E-CR and L-CR, act as moderating factors between baseline ventricular size and clinical dementia severity at baseline and across 2 years. We further examined whether this moderation is differentially represented by sex.MethodsWe examined a longitudinal model using patients (N = 723; mean age = 70.8 ± 9.4 years; age range = 38–90 years; females = 374) from the Sunnybrook Dementia Study. The patients represented Alzheimer’s disease (n = 439), mild cognitive impairment (n = 77), vascular cognitive impairment (n = 52), Lewy body disease (n = 30), and frontotemporal dementia (n = 125). Statistical analyses included (1) latent growth modeling to determine how clinical dementia severity changes over 2 years (measured by performance on the Dementia Rating Scale), (2) confirmatory factor analysis to establish a baseline E-CR factor, and (3) path analysis to predict dementia severity. Baseline age (continuous) and Apolipoprotein E status (ɛ4−/ɛ4+) were included as covariates.ResultsThe association between higher baseline ventricular size and dementia severity was moderated by (1) E-CR and L-CR and (2) CR-P. This association was differentially represented in men and women. Specifically, men in only the low CR-P had higher baseline clinical dementia severity with larger baseline ventricular size. However, women in the low CR-P showed the (1) highest baseline dementia severity and (2) fastest 2-year decline with larger baseline ventricular size.ConclusionsClinical dementia severity associated with ventricular size may be (1) selectively moderated by complex and additive CR networks and (2) differentially represented by sex.Trials registrationClinicalTrials.gov, NCT01800214. Registered on 27 February 2013.Electronic supplementary materialThe online version of this article (10.1186/s13195-018-0419-2) contains supplementary material, which is available to authorized users.

Ontario Neurodegenerative Disease Research Initiative (ONDRI): Structural MRI methods & outcome measures

“…With the SABRE-LE method, choroid plexus are not arbitrarily removed or re-classified as CSF and thus remain as part of the overall tissue segmentation. Ventricular volumes are often used as a simple indicator of overall brain atrophy, and have the potential for use as a differential indicator of disease and dementia severity (Fig.6) (Nestor et al, 2008;Sapkota et al, 2018;Tavares et al, 2019).…”

Ontario Neurodegenerative Disease Research Initiative (ONDRI): Structural MRI Methods and Outcome Measures

“…With the SABRE-LE method, choroid plexus are not arbitrarily removed or re-classified as CSF and thus remain as part of the overall tissue segmentation. Ventricular volumes are often used as a simple indicator of overall brain atrophy, and have the potential for use as a differential indicator of disease and dementia severity ( Figure 6) (43)(44)(45).…”

Reserva cognitiva y demencias: Limitaciones del efecto protector en el envejecimiento y el deterioro cognitivoLimited protective effects of cognitive reserve on the progression of cognitive impairment

“…En un estudio longitudinal se analizó la RC (durante dos años) en función del sexo y el volumen ventricular en pacientes con EA, deterioro cognitivo vascular, demencia con cuerpos de Lewy y demencia frontotemporal. Los resultados sugieren diferencias significativas en función del género: hombres con una alta RC y un gran volumen ventricular, variaron levemente el grado de severidad de la demencia tras dos años de iniciado el estudio, lo cual no se reflejó en mujeres, donde la demencia evolucionó a compromiso cognitivo severo 46 . Los hallazgos son consistentes con otros estudios en pacientes con demencia tipo Alzheimer, donde la prevalencia fue mayor en mujeres, y las repercusiones cognitivas progresaron rápidamente a un estado de deterioro cognitivo avanzado [47][48][49] .…”