AbstractBackgroundCognitive reserve (CR) is the capacity of an individual to maintain cognitive function despite brain damage (Stern et al., 2002). It moderates the effect of Alzheimer’s disease (AD)‐related brain damage on cognition, which is difficult to demonstrate using residual analysis. Recent research has shown a strong effect of tauopathy on the brain damage (Renaud La Joie et al., 2020), but how the CR affects this relationship is still unknown.MethodWe obtained 121 amyloid‐positive individuals, including 15 cognitive unimpaired (CU) individuals, 44 patients with mild cognitive impairment (MCI), and 58 AD. We first identified structural connectivity subnetworks where the relationships between edges’ weights (the number of streamlines) and tauopathy (global cortical tau standard uptake value ratio, standardized by the mean and standard deviation of the amyloid‐negative CU individuals) were modified by the years of education, as a proxy for cognitive reserve, using the network‐based statistics. We chose a subnetwork where its total connectivity significantly mediated the effect of the tauopathy on memory score, based on the Baron and Kenny method (Baron, Kenny et al., 1986). Through the path analysis, we verified the moderated mediation model, in which the moderating effects of education were added to the mediation model.ResultOne subnetwork whose edges were significantly affected by the tauopathy and moderation of education showed partial mediation in the tauopathic mechanism on cognition. The moderated mediation model based on the total connectivity of the subnetwork showed an appropriate model fit (CFI = 0.999, SRMR = 0.006) and a significant moderating effect on both stages of the indirect effect path of mediation when tested using the bootstrap method with 10000 resamples. The simple slope and intercept analyses implied that the highly educated individuals on the AD continuum show higher memory function than the lower educated individuals in the absence of tauopathy, but this score decreased more rapidly as tau increased.ConclusionWe conclude that education modifies the effect of tauopathy on structural connectivity as well as the effect of structural connectivity on cognition when AD‐related tauopathy affects memory score through the structural connectivity subnetwork.
Read full abstract