Rate of MMSE score change in Alzheimer's disease: influence of education and vascular risk factors.
OBJECTIVE
To test whether higher education accelerates Alzheimer's Disease (AD) progression rate through an effect on the cognitive reserve capabilities of an individual.


METHODS
We investigated the influence of schooling and other demographic and clinical conditions (including age, sex, diabetes, arterial hypertension, and acetyl cholinesterase inhibitor--AcheI--therapy) on Mini Mental Status Examination (MMSE) score changes over time in 162 AD patients as well as the interaction of schooling with the above conditions using the Generalized Estimated Equation procedure.


RESULTS
Generalized Estimated Equation procedure yielded an overall progression rate of 0.24 MMSE points per month. Patients with education > or = 8 years showed a faster cognitive decline. Male sex, occurrence of arterial hypertension and type II diabetes, and lack of AcheI therapy were associated to faster decline. Stratifying by gender, vascular risk factors, and AcheI therapy, we observed a significant interaction between education and time in the subgroup of patients who had vascular risk factors, and in those who were not treated with AcheI.


CONCLUSIONS
These results confirm that schooling may be a significant predictor of cognitive decline as measured by MMSE in persons with AD and provide epidemiological support to "cognitive reserve" model.
Roselli
Francesco
F
Department of Neurological and Psychiatric Sciences, University of Bari, I - 70124 Bari, Italy.
Tartaglione
Bruno
B
Federico
Francesco
F
Lepore
Vito
V
Defazio
Giovanni
G
Livrea
Paolo
P
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000209:etiology* / Q000523:psychology; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D003071:Cognition; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D018450:Disease Progression; D004522:Educational Status; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors
D002800:Cholinesterase Inhibitors