Inverse relationship between education and parietotemporal perfusion deficit in Alzheimer's disease

TLDR

Higher dementia prevalence among less educated people suggests education may protect against Alzheimer’s disease. The study examined whether individuals with more years of education exhibit more advanced Alzheimer’s pathology before clinical symptoms appear. Regional cerebral blood flow was measured with 133Xe inhalation, and three clinically matched AD groups with varying education levels were compared, revealing similar whole‑cortex flows but differing parietotemporal perfusion. The group with the highest education showed a larger parietotemporal perfusion deficit, indicating more advanced Alzheimer’s disease and supporting the idea that education provides a reserve that delays clinical onset.

Abstract

Abstract A higher prevalence of dementia in individuals with fewer years of education has suggested that education may protect against Alzheimer's disease (AD). We tested whether individuals with more years of education have a more advanced AD before it is clinically evident. As a measure of pathophysiological severity, we quantified regional cerebral blood flow (rCBF), by the 133 Xenon inhalation technique; a specific pattern of flow reduction in the parietotemporal cortex corresponds to AD pathology. In 3 groups of patients with probable AD, matched for clinical measures of dementia severity but with varying levels of education, whole‐cortex mean flows were comparable. However, the parietotemporal perfusion deficit was significantly greater in the group with the highest level of education, indicating that AD was more advanced in this group. We conclude that education or its covariates or both may provide a reserve that compensates for the neuropathological changes of AD and delays the onset of its clinical manifestations.