Association Between Educational Attainment And Amyloid Deposition Across The Spectrum From Normal Cognition To Dementia: A Systematic Review And Meta Analysis - Info and Reading Options

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Alzheimer’s disease (AD) is a progressive neurodegenerative disease characterized by cognitive impairment as core symptoms in the elderly. AD represents a substantial burden on patients, families, and societies . Although some pharmacological treatments are clinically available for alleviating par 40 tially the symptoms of AD, no disease-modifying or preventative treatments have been developed. Thus, there is an urgent need to develop new effective therapeutic methods to overcome the medical and socioeconomic issues associated with AD. To this end, elaborate research is warranted to understand the pathology of AD. Mounting evidence has supported the amyloid cascade hypothesis, which states that excessive accumulation of a peptide called amyloid may be the key contributor associated with the onset of AD. According to this hypothesis, the pathology of AD gradually progresses in the order of accumulation of amyloid- , reduced cerebral blood flow and hypometabolism of glucose, brain atrophy, and then cognitive decline in this population. However, it is also known that there is an inter-individual difference in the relationship between the pathological change in the brain and the onset of cognitive symptoms. Brain reserve is a hypothetical concept that explains this individual heterogeneity: the more the reserve, the more change required to cause symptoms. Stern conceptualized cognitive reserve as functional aspect of such reserve reflecting individual life experience, as opposed quantitative aspect of the reserve such as the number of neurons the brain can lose while maintaining its function. Education has been regarded as one of the most important contributors to cognitive reserve. Murray et al. revealed that educational attainment has a positive effect on late-life cognitive function in elderly people without dementia. McDowell et al. found that high levels of educational attainment protect against progress of dementia. Education is considered to have a protective effect against both cognitive decline and atrophy associated with aging and dementia possibly through neuroplasticity. For instance, a previous meta-analysis noted that brain size is positively correlated with intellectual levels especially in cognitively normal elderly adults. In contrast, in participants with AD, a review article summarized that there is a negative correlation between cognitive reserve and brain size. However, there are few reports that examine the relationship between cognitive reserve and AD-related brain imaging biomarkers. Further, it still remains unclear how education levels modify the pathology of AD. Furthermore, since mild cognitive impairment (MCI) is considered as an intermediary stage between normal aging and AD, it is important to explore this critical clinical stage to understand the underlying pathology of AD. However, few studies have examined relationships between education levels and brain imaging biomarkers related to AD pathology among participants with MCI.

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