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J Neurol Neurosurg Psychiatry. 2019 Oct;90(10):1124-1130. doi: 10.1136/jnnp-2019-320439. Epub 2019 Jun 10.

Education modulates brain maintenance in presymptomatic frontotemporal dementia.

Author information

1
Centre for Neurodegenerative Disorders, Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
2
Department of Brain and Behavioral Science, Medical and Genomic Statistics Unit, University of Pavia, Pavia, Italy.
3
Stroke Unit, Neurology Unit, Spedali Civili Hospital, Brescia, Italy.
4
Neurology Unit, Spedali Civili Hospital, Brescia, Italy.
5
Biotechnology Laboratory, Department of Diagnostics, Spedali Civili Hospital, Brescia, Italy.
6
Neuroradiology Unit, University of Brescia, Brescia, Italy.
7
Department of Neurology, Erasmus Medical Center, Rotterdam, Netherlands.
8
Centro Dino Ferrari, University of Milan, Milan, Italy.
9
Neurodegenerative Diseases Unit, Fondazione IRCSS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
10
Neurology Department, Hospital Clinic, Institut d'Investigacions Biomèdiques, Barcelona, Spain.
11
Clinique Interdisciplinaire de Mémoire, Département des Sciences Neurologiques, CHU de Québec, and Faculté de Médecine, Université Laval, Québec, Quebec, Canada.
12
Department of Neurology, Hospital Universitario Donostia, San Sebastian, Gipuzkoa, Spain.
13
Department of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research & Center of Neurology, University of Tübingen, Tübingen, Germany.
14
German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany.
15
Karolinska Institutet, Department NVS, Center for Alzheimer Research, Division of Neurogenetics, Stockholm, Sweden.
16
LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, Toronto, Ontario, Canada.
17
Toronto Western Hospital, Tanz Centre for Research in Neurodegenerative Disease, Toronto, Ontario, Canada.
18
Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.
19
Department of Neurosciences, Laboratory for Cognitive Neurology, KU Leuven, Leuven, Belgium.
20
Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada.
21
Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologico Carlo Besta, Milan, Italy.
22
Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
23
Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
24
Department of Clinical Neurology, University of Oxford, Oxford, United Kingdom.
25
Department of Psychiatry, McGill University Health Centre, McGill University, Montreal, Quebec, Canada.
26
McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.
27
Institute of Brain, Behaviour and Mental Health, The University of Manchester, Withington, Manchester, United Kingdom.
28
Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität, Munich, German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.
29
Department of Neurology, University Hospital Ulm, Ulm, Germany.
30
Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
31
Memory Clinic and LANVIE-Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Geneva, Switzerland.
32
Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.
33
Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) "Don Gnocchi", Florence, Italy.
34
Dementia Research Centre, UCL Institute of Neurology, London, United Kingdom.
35
Centre for Neurodegenerative Disorders, Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy bborroni@inwind.it.

Abstract

OBJECTIVE:

Cognitively engaging lifestyles have been associated with reduced risk of conversion to dementia. Multiple mechanisms have been advocated, including increased brain volumes (ie, brain reserve) and reduced disease progression (ie, brain maintenance). In cross-sectional studies of presymptomatic frontotemporal dementia (FTD), higher education has been related to increased grey matter volume. Here, we examine the effect of education on grey matter loss over time.

METHODS:

Two-hundred twenty-nine subjects at-risk of carrying a pathogenic mutation leading to FTD underwent longitudinal cognitive assessment and T1-weighted MRI at baseline and at 1 year follow-up. The first principal component score of the graph-Laplacian Principal Component Analysis on 112 grey matter region-of-interest volumes was used to summarise the grey matter volume (GMV). The effects of education on cognitive performances and GMV at baseline and on the change between 1 year follow-up and baseline (slope) were tested by Structural Equation Modelling.

RESULTS:

Highly educated at-risk subjects had better cognition and higher grey matter volume at baseline; moreover, higher educational attainment was associated with slower loss of grey matter over time in mutation carriers.

CONCLUSIONS:

This longitudinal study demonstrates that even in presence of ongoing pathological processes, education may facilitate both brain reserve and brain maintenance in the presymptomatic phase of genetic FTD.

KEYWORDS:

brain maintenance; brain reserve; frontotemporal dementia (FTD); graph theory; magnetic resonance imaging (MRI)

PMID:
31182509
DOI:
10.1136/jnnp-2019-320439

Conflict of interest statement

Competing interests: None declared.

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