title: Neuroanatomical correlates of cognitive reserve in Alzheimer disease.
abstract: Cognitive reserve (CR), for which formal education represents a proxy index, has been claimed as a factor mitigating the clinical manifestations of Alzheimer disease (AD). The aim of this study was to assess the impact of formal education in modifying the relationship between cerebral grey matter (GM) damage and clinical manifestations in a large cohort of patients with AD or amnesic mild cognitive impairment (a-MCI). We recruited 22 patients with AD and 23 with a-MCI, and we classified them in subjects with high (HEL) or low educational level (LEL). All patients underwent a neuropsychological assessment and magnetic resonance imaging (MRI) scanning at 3T. T1-weighted volumes were analyzed, using voxel-based morphometry, for GM investigation. A 1-year clinical follow-up was available for part of the a-MCI patients. There were no between-groups differences in clinical features, memory, and language functions. Conversely, HEL subjects performed better in all tests assessing visuo-spatial abilities. GM volumes of LEL compared with HEL patients were reduced in the supramarginal gyrus bilaterally and in the right posterior cingulate/precuneus and frontal opercular cortex. Conversely, HEL compared with LEL patients showed reduced GM volumes in the entorhinal cortices and temporal poles, regions typically affected by AD pathology. These results remained unchanged when including in the analysis of only patients with clinically proven AD (AD and a-MCI converters). This study suggests that CR produces selective GM changes that mitigate the clinical impact of AD. Moreover, it supports the idea that CR is based on several "brain reserves" rather than on a generalized increase of brain plasticity.
authors.affiliation: Neuroimaging Laboratory, Santa Lucia Foundation, IRCCS, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Serra
authors.forename: Mara
authors.initials: M
authors.lastname: Cercignani
authors.forename: Laura
authors.initials: L
authors.lastname: Petrosini
authors.forename: Barbara
authors.initials: B
authors.lastname: Basile
authors.forename: Roberta
authors.initials: R
authors.lastname: Perri
authors.forename: Lucia
authors.initials: L
authors.lastname: Fadda
authors.forename: Barbara
authors.initials: B
authors.lastname: Spanò
authors.forename: Camillo
authors.initials: C
authors.lastname: Marra
authors.forename: Franco
authors.initials: F
authors.lastname: Giubilei
authors.forename: Giovanni A
authors.initials: GA
authors.lastname: Carlesimo
authors.forename: Carlo
authors.initials: C
authors.lastname: Caltagirone
authors.forename: Marco
authors.initials: M
authors.lastname: Bozzali
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000473:pathology*; D001921:Brain / Q000473:pathology; D003072:Cognition Disorders / Q000473:pathology; D058245:Cognitive Reserve / Q000502:physiology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests