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The role of education in resistance against development of vascular brain pathology
Author(s) -
van Arendonk Joyce,
Yilmaz Pinar,
Steketee Rebecca,
Zijlmans Jendé L,
Lamballais Sander,
Ikram M Arfan,
Vernooij Meike W
Publication year - 2020
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1002/alz.043138
Subject(s) - hyperintensity , dementia , medicine , cognitive reserve , stroke (engine) , framingham risk score , vascular dementia , neuropathology , population , framingham heart study , cardiology , pathology , psychology , disease , magnetic resonance imaging , radiology , engineering , mechanical engineering , environmental health
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.