The role of education in resistance against development of vascular brain pathology: Epidemiology / Risk and protective factors in MCI and dementia. (7th December 2020)

• Record Type: Journal Article
• Authors: van Arendonk, Joyce; Yilmaz, Pinar; Steketee, Rebecca; Zijlmans, Jendé L; Lamballais, Sander; Ikram, M Arfan; Vernooij, Meike W
• Is Part Of: Alzheimer's & dementia. Volume 16(2020)Supplement 10
• Page Start: n/a
• Page End: n/a
• Publication Date: 2020-12-07
• Subjects: Alzheimer's disease -- Periodicals; Alzheimer Disease -- Periodicals; Dementia -- Periodicals; Démence; Maladie d'Alzheimer; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.83
• DOI: 10.1002/alz.043138
• Languages: English
• ISSNs: 1552-5260

Abstract

Abstract: Background: Vascular brain pathology due to cerebral small vessel disease is one of the leading causes of cognitive decline and dementia in the elderly. The concept of brain resistance postulates that individuals with the same amount of risk factors show different levels of neuropathology than expected based on their risk profile. In this study, we investigate the role of education, as proxy for resistance, on the development of brain pathology due to vascular risk factors. Method: 4440 participants without stroke or dementia were included from the population‐based Rotterdam study (mean age, 62.9±10, 7 years). Structural MRI was measured on a 1.5T MRI scanner and comprehensive psychometric data was obtained. Educational attainment was assessed during the baseline interview and classified in three categories. Hypertension and the Framingham Stroke Risk Profile were used as the primary vascular risk factors of interest. Vascular brain pathology as outcome was assessed by white matter hyperintensities (WMH), microbleeds and lacunar infarcts. We used multiple linear regression models to determine the relation between vascular risk factors and brain pathology, stratified by educational level. Result: Significant interaction effects between education and hypertension were found on their association with WMH, hippocampal volume and microbleeds. The association of hypertension with hippocampal volume differed significantly across strata of education: β=0.02, 95%CI ‐0.07‐0.11 for high education compared to β=‐0.12 95%CI ‐0.21‐ ‐0.03 for low education. Moreover, the association of hypertension with WMH differed significantly between the intermediate and low education strata, and differed borderline significantly between the high and low education strata: β=0.15, 95%CI 0.08‐0.22 for high education, β=0.20, 95%CI 0.11‐0.29 for intermediate education and β=0.28, 95%CI 0.18‐0.38 for low education. Lastly, the association of hypertension with microbleeds also differed significantly across strata of education: β= 0.00, 95%CI ‐0.04‐0.03 for intermediate education compared to β=0.05, 95%CI ‐0.01‐0.10 for low education. Conclusion: A similar vascular risk profile leads to fewer WMH, microbleeds and less hippocampal atrophy in participants with a higher education level compared to persons with lower education. This suggests that people with a higher education level are more resistant against vascular brain pathology and hippocampal atrophy due to vascular risk factors.