title: Higher education affects accelerated cortical thinning in Alzheimer's disease: a 5-year preliminary longitudinal study.
abstract: BACKGROUND
  Epidemiological studies have reported that higher education (HE) is associated with a reduced risk of incident Alzheimer's disease (AD). However, after the clinical onset of AD, patients with HE levels show more rapid cognitive decline than patients with lower education (LE) levels. Although education level and cognition have been linked, there have been few longitudinal studies investigating the relationship between education level and cortical decline in patients with AD. The aim of this study was to compare the topography of cortical atrophy longitudinally between AD patients with HE (HE-AD) and AD patients with LE (LE-AD).
  
  
  METHODS
  We prospectively recruited 36 patients with early-stage AD and 14 normal controls. The patients were classified into two groups according to educational level, 23 HE-AD (>9 years) and 13 LE-AD (≤9 years).
  
  
  RESULTS
  As AD progressed over the 5-year longitudinal follow-ups, the HE-AD showed a significant group-by-time interaction in the right dorsolateral frontal and precuneus, and the left parahippocampal regions compared to the LE-AD.
  
  
  CONCLUSIONS
  Our study reveals that the preliminary longitudinal effect of HE accelerates cortical atrophy in AD patients over time, which underlines the importance of education level for predicting prognosis.
authors.affiliation: Department of Neurology,Samsung Medical Center,Sungkyunkwan University School of Medicine,Seoul,South Korea.
authors.forename: Hanna
authors.initials: H
authors.lastname: Cho
authors.affiliation: Department of Biomedical Engineering,Hanyang University,Seoul,South Korea.
authors.forename: Seun
authors.initials: S
authors.lastname: Jeon
authors.affiliation: Department of Preventive Medicine and the Institute for Environmental Research.
authors.forename: Changsoo
authors.initials: C
authors.lastname: Kim
authors.affiliation: Department of Neurology,Yonsei University College of Medicine,Seoul,South Korea.
authors.forename: Byoung Seok
authors.initials: BS
authors.lastname: Ye
authors.affiliation: Department of Neurology,Ewha Womans University Mokdong Hospital,Ewha Womans University School of Medicine,Seoul,South Korea.
authors.forename: Geon Ha
authors.initials: GH
authors.lastname: Kim
authors.affiliation: Department of Neurology,Gachon University Gil Medical Center,Incheon,South Korea.
authors.forename: Young
authors.initials: Y
authors.lastname: Noh
authors.affiliation: Department of Neurology,Samsung Medical Center,Sungkyunkwan University School of Medicine,Seoul,South Korea.
authors.forename: Hee Jin
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Neurology,Inha University School of Medicine,Incheon,South Korea.
authors.forename: Cindy W
authors.initials: CW
authors.lastname: Yoon
authors.affiliation: Department of Neurology,Samsung Medical Center,Sungkyunkwan University School of Medicine,Seoul,South Korea.
authors.forename: Yeo Jin
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Neurology,Samsung Medical Center,Sungkyunkwan University School of Medicine,Seoul,South Korea.
authors.forename: Jung-Hyun
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Neurology,Samsung Medical Center,Sungkyunkwan University School of Medicine,Seoul,South Korea.
authors.forename: Sang Eon
authors.initials: SE
authors.lastname: Park
authors.affiliation: Department of Radiology,Samsung Medical Center,Sungkyunkwan University School of Medicine,Seoul,South Korea.
authors.forename: Sung Tae
authors.initials: ST
authors.lastname: Kim
authors.affiliation: Department of Biomedical Engineering,Hanyang University,Seoul,South Korea.
authors.forename: Jong-Min
authors.initials: JM
authors.lastname: Lee
authors.affiliation: Department of Neurology,Samsung Medical Center,Sungkyunkwan University School of Medicine,Seoul,South Korea.
authors.forename: Sue J
authors.initials: SJ
authors.lastname: Kang
authors.affiliation: Department of Neurology,Samsung Medical Center,Sungkyunkwan University School of Medicine,Seoul,South Korea.
authors.forename: Mee Kyung
authors.initials: MK
authors.lastname: Suh
authors.affiliation: Department of Neurology,Samsung Medical Center,Sungkyunkwan University School of Medicine,Seoul,South Korea.
authors.forename: Juhee
authors.initials: J
authors.lastname: Chin
authors.affiliation: Department of Neurology,Samsung Medical Center,Sungkyunkwan University School of Medicine,Seoul,South Korea.
authors.forename: Duk L
authors.initials: DL
authors.lastname: Na
authors.affiliation: Biostatics of Collaboration Unit,Yonsei University College of Medicine,Seoul,South Korea.
authors.forename: Dae Ryong
authors.initials: DR
authors.lastname: Kang
authors.affiliation: Department of Neurology,Samsung Medical Center,Sungkyunkwan University School of Medicine,Seoul,South Korea.
authors.forename: Sang Won
authors.initials: SW
authors.lastname: Seo
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000175:diagnosis / Q000523:psychology; D001284:Atrophy; D001931:Brain Mapping / Q000379:methods; D002540:Cerebral Cortex / Q000473:pathology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D018450:Disease Progression; D004522:Educational Status; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D013223:Statistics as Topic