title: Educational attainment and motor burden in Parkinson's disease.
abstract: OBJECTIVE
  Greater educational attainment is a protective factor for neurodegenerative dementias. If education earlier in life leads to greater cerebral reserve, it may play a similar protective role in Parkinson's disease (PD).
  
  
  METHODS
  We conducted a cross-sectional clinical imaging study of 142 subjects with PD. All subjects underwent [(11)C]dihydrotetrabenazine PET to confirm nigrostriatal dopaminergic denervation and brain MRI to estimate adjusted cortical gray matter volume (GMV).
  
  
  RESULTS
  After adjusting for possible confounders, including cognitive and dopaminergic covariates, as well as nonspecific neurodegeneration covariates (age, disease duration, and total adjusted cortical GMV), lower years of education remained a significant predictor of higher total MDS-UPDRS motor score (t = -3.28; P = 0.001). Education level associated inversely with white matter (WM) hyperintensities in a post-hoc analysis (n = 83).
  
  
  CONCLUSIONS
  Higher educational attainment is associated with lower severity of motor impairment in PD. This association may reflect an extranigral protective effect upon WM integrity.
authors.affiliation: Department of Neurology, University of Michigan, Ann Arbor, Michigan, USAI.
authors.forename: Vikas
authors.initials: V
authors.lastname: Kotagal
authors.affiliation: Department of Neurology, University of Michigan, Ann Arbor, Michigan, USAI.|Neurology Service and GRECC, VAAAHS, Ann Arbor, Michigan, USA.|Department of Radiology, Division of Nuclear Medicine, University of Michigan, Ann Arbor, Michigan, USA.|University of Michigan Morris K. Udall Center, Ann Arbor, Michigan, USA.
authors.forename: Nicolaas I
authors.initials: NI
authors.lastname: Bohnen
authors.affiliation: Department of Radiology, Division of Nuclear Medicine, University of Michigan, Ann Arbor, Michigan, USA.|University of Michigan Morris K. Udall Center, Ann Arbor, Michigan, USA.
authors.forename: Martijn L T M
authors.initials: ML
authors.lastname: Müller
authors.affiliation: Department of Radiology, Division of Nuclear Medicine, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Koeppe
authors.affiliation: Department of Neurology, University of Michigan, Ann Arbor, Michigan, USAI.|Department of Radiology, Division of Nuclear Medicine, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Kirk A
authors.initials: KA
authors.lastname: Frey
authors.affiliation: Department of Internal Medicine and VA Ann Arbor Center for Clinical Management Research, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Langa
authors.affiliation: Department of Neurology, University of Michigan, Ann Arbor, Michigan, USAI.|Neurology Service and GRECC, VAAAHS, Ann Arbor, Michigan, USA.|University of Michigan Morris K. Udall Center, Ann Arbor, Michigan, USA.
authors.forename: Roger L
authors.initials: RL
authors.lastname: Albin
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D066128:Gray Matter / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000473:pathology* / Q000503:physiopathology*; D049268:Positron-Emission Tomography; D065840:Protective Factors; D012720:Severity of Illness Index; D066127:White Matter / Q000473:pathology*
keywords: Parkinson's disease; dopamine; education; gray matter; neuroprotection