Abstract
The purpose of this study was to investigate whether brain and cognitive reserves were associated with the clinical progression of AD dementia. We included participants with AD dementia from the Alzheimer’s Disease Neuroimaging Initiative, provided they were followed up at least once, and candidate proxies for cognitive (education for early-life reserve and Adult Reading Test for late-life reserve) or brain reserve (intracranial volume [ICV] for early-life reserve and the composite value of [18F] fluorodeoxyglucose positron emission tomography regions of interest (FDG-ROIs) for late-life reserve) were available. The final analysis included 120 participants. Cox proportional hazards model revealed that FDG-ROIs were the only significant predictor of clinical progression. Subgroup analysis revealed a significant association between FDG-ROIs and clinical progression only in the larger ICV group (HR = 0.388, p = 0.028, 95% CI 0.167–0.902). Our preliminary findings suggest that relatively preserved cerebral glucose metabolism might delay further clinical progression in AD dementia, particularly in the greater ICV group. In addition to ICV, cerebral glucose metabolism could play an important role as a late-life brain reserve in the process of neurodegeneration. Distinguishing between early- and late-life reserves, and considering both proxies simultaneously, would provide a wider range of factors associated with the prognosis of AD dementia.
Highlights
The primary goal of Alzheimer’s Disease Neuroimaging Initiative (ADNI) has been to test whether serial magnetic resonance imaging (MRI), positron emission tomography (PET), other biological markers, and clinical and neuropsychological assessment can be combined to measure the progression of mild cognitive impairment (MCI) and early Alzheimer’s disease (AD)
In the current retrospective study, we demonstrated that brain reserve, not cognitive reserve, was associated with interindividual resilience to further clinical deterioration in AD dementia
Our preliminary findings suggest that relatively preserved cerebral glucose metabolism might delay further clinical progression in AD dementia, in the greater intracranial volume (ICV)
Summary
As the global elderly population increases rapidly, the prevalence of dementia is increasing worldwide. The average prevalence of Alzheimer’s disease (AD). Given that dementia management is becoming a key public health priority, it is important to determine the prognosis of clinical progression after dementia diagnosis. According to the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-V) [2], significant cognitive impairment is required to be diagnosed with major neurocognitive disorder, which corresponds to dementia. Cognitive function gradually worsens as dementia advances. In terms of individual perspective, there is a large variance in the pattern of clinical progression; for example, some people show greater cognitive decline, but others show less cognitive change during the disease course in dementia
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