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Examining the Reserve Hypothesis in Parkinson's Disease: A Longitudinal Study
Author(s) -
Lee PeiChen,
Artaud Fanny,
CormierDequaire Florence,
Rascol Olivier,
Durif Franck,
Derkinderen Pascal,
Marques AnaRaquel,
Bourdain Frédéric,
Brandel JeanPhilippe,
Pico Fernando,
Lacomblez Lucette,
Bonnet Cecilia,
BrefelCourbon Christine,
OryMagne Fabienne,
Grabli David,
Klebe Stephan,
Mangone Graziella,
You Hana,
Mesnage Valérie,
Brice Alexis,
Vidailhet Marie,
Corvol JeanChristophe,
Elbaz Alexis
Publication year - 2019
Publication title -
movement disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.352
H-Index - 198
eISSN - 1531-8257
pISSN - 0885-3185
DOI - 10.1002/mds.27854
Subject(s) - cognitive reserve , psychology , dementia , cohort , rating scale , cognition , anxiety , parkinson's disease , depression (economics) , disease , physical therapy , medicine , physical medicine and rehabilitation , psychiatry , developmental psychology , economics , macroeconomics
Background Whether reserve plays a role in Parkinson's disease (PD) patients has received less attention than in dementia and has been mainly examined in relation with cognitive function. Objective To investigate whether reserve plays a role in the severity and progression of motor, cognitive, and nonmotor PD symptoms by examining whether education level (proxy of reserve) is associated with baseline performance and rate of progression. Methods We used data from a longitudinal cohort of PD patients (≤5‐year disease duration at baseline) annually followed up to 5 years (n = 393; 41% women; mean age = 62.3 years, standard deviation = 10.0; mean disease duration = 2.6 years, standard deviation = 1.5). We examined the relationship of education with time to reach Hoehn and Yahr stage ≥3 using Cox regression and with baseline severity and progression of motor (Movement Disorder Society–Unified Parkinson's Disease Rating Scale parts II and III, gait speed), cognitive (Mini‐Mental State Examination), and nonmotor (depression, anxiety, nonmotor symptoms scale, quality of life) symptoms using mixed models. Results Education level was not associated with age at onset or diagnosis. Compared with the low‐education group, the incidence of Hoehn and Yahr ≥3.0 was 0.42 times lower (95% confidence interval, 0.22–0.82, P = 0.012) in the high‐education group. Higher education was associated with better baseline motor function ( P < 0.001), but not with the rate of motor decline ( P > 0.15). Similar results were observed for cognition. Education was not associated with nonmotor symptoms. Conclusions Higher education is associated with better baseline motor/cognitive function in PD, but not with rate of decline, and with a lower risk of reaching Hoehn and Yahr ≥3 during the follow‐up. Our observations are consistent with a passive reserve hypothesis for motor/cognitive symptoms. © 2019 International Parkinson and Movement Disorder Society