The effect of education on rCBF changes in Alzheimer’s disease: a longitudinal SPECT study

Abstract

To determine the relationship of differing levels of education on regional cerebral blood flow (rCBF) in patients with Alzheimer's disease (AD). Fifty-three patients with AD followed-up for an average of 36 months were divided into the high-educated group (HE, >or=12 years of schooling) and low-educated group (LE, <12 years of schooling). The cognitive and functional impairment was assessed using the Mini-Mental State Examination (MMSE) and the Functional Assessment Staging (FAST), respectively. Initial and follow-up rCBF were assessed using SPECT with N-isopropyl-p-[(123)I]-iodoamphetamine and the SPECT data were analyzed by 3D-stereotactic surface projections. At initial evaluation, the HE group had greater rCBF deficits in the parietotemporal regions than did the LE group, even though both groups had comparable MMSE and FAST scores. When compared with initial SPECT, follow-up SPECT showed a significant rCBF reduction in widespread regions, including the frontal, parietal, temporal, and limbic lobes of the HE group, while it a significant rCBF reduction in scattered and small regions of the parietotemporal, cingulate, and occipital areas of the LE group, as the HE group had faster cognitive and functional decline than the LE group. The HE group showed lower rCBF at initial SPECT than the LE group, suggesting more advanced AD pathology. As a result, the HE group demonstrated a more extensive and severe reduction of rCBF on follow-up SPECT in association with faster cognitive and functional decline than the LE group. Our SPECT study provides stronger support for the cognitive reserve effects of education in AD.