The Clinical Characteristics according to the Educational Level in the Elderly Patients with Mild Alzheimer's Disease Dementia

Abstract

Background and Purpose Cognitive reserve is important for the individual susceptibility to dementia. Among the various determinants of cognitive reserve, the number of years of formal education would be of prime importance. We performed this study to explore its contribution to the clinical characteristics of dementia. Methods We included consecutive mild Alzheimer's disease (AD) dementia patients (clinical dementia rating, CDR=0.5 or 1) who visited our memory clinic and were older than 70 years at the evaluation from October 2013 to September 2015. According to the number of years of education, the corresponding subjects was grouped into two extreme educational groups, low education (illiterate or partially illiterate, LE, n=43) vs. high education (more than 9 years of education, HE, n=34). Among these patients, we compared various demographic, neuropsychological and neuroimaging characteristics. Results The groups were comparable in terms of age, frequency of hypertension and diabetes, and CDR and its sum of box. However, female gender was more frequent in the LE group (p=0.000). Also this group showed a more depressive mood on the geriatric depression scale (p=0.007). The raw scores on Korean Version of Mini-Mental State Examination and well-validated neuropsychological tests were lower in the LE group. However, the cognitive performance was found to be more preserved in the LE group than in the HE group when assessed using the z-score in certain specified tests on univariate and multivariate analyses (p<0.05). The Schelten's grade of medial temporal atrophy was similar between the two educational groups. Also, the degree of combined ischemic burden did not differ between the two groups. Conclusions We identified that the prevalence of depressive mood and the extent of decline from the corresponding norm in a particular neuropsychological performance differ according to the educational level of mild AD patients.

The correlation of neuropsychological evaluation with 11C-PiB and 18F-FC119S amyloid PET in mild cognitive impairment and Alzheimer disease

“…[11] We analyzed these z-scores because the z-scores are elaborately defined and enable to minimize the effects of illiteracy. [18] Thus zscore allows precise comparative analysis between the various subjects. Additionally, K-MMSE and CDR were also evaluated.…”

“…Table 4 showed correlation of neuropsychological domain in SNSB with 18 F-FC119S PET/CT. In MCI groups, copy score of RCFT showed significant negative correlation with SUVR of frontal cortex (Fig.…”

“…[1,14] Also, 11 C-PiB-PET appeared to positive in 50% to 60% of MCI subjects. [1] However, short radioactive half-life has been the major limitation of 11 C-PiB PET, preventing its widespread use, and therefore, other 18 F-labeled PET tracers have been developed. [2] Among them, 18 F-FC119S was introduced as a new Aß PET tracer which showed excellent binding affinity for synthetic Aß 1-42 aggregates and rapid clearance in preclinical study.…”

“…[1] However, short radioactive half-life has been the major limitation of 11 C-PiB PET, preventing its widespread use, and therefore, other 18 F-labeled PET tracers have been developed. [2] Among them, 18 F-FC119S was introduced as a new Aß PET tracer which showed excellent binding affinity for synthetic Aß 1-42 aggregates and rapid clearance in preclinical study. [15] In the previous study with 10 MCI and 10 AD patients, we showed that the cortical uptakes of 18 F-FC119S were significantly correlated with those of 11 C-PiB-PET/CT, and so this new PET tracer can be effectively available for Aß imaging with longer radioactive half-lives.…”

“…[15] In the previous study with 10 MCI and 10 AD patients, we showed that the cortical uptakes of 18 F-FC119S were significantly correlated with those of 11 C-PiB-PET/CT, and so this new PET tracer can be effectively available for Aß imaging with longer radioactive half-lives. [2] However, except for imaging comparison of 18 F-FC119S and 11 C-PiB-PET, comprehensive analysis of neuropsychological tests in MCI and AD patients has not been performed. For the widespread clinical application of novel PET tracer, correlation between novel PET tracer and current standard neuropsychological tests need to be defined.…”