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Schooling mediates brain reserve in Alzheimer’s disease: findings of fluoro-deoxy-glucose-positron emission tomography
  1. R Perneczky1,
  2. A Drzezga2,
  3. J Diehl-Schmid1,
  4. G Schmid1,
  5. A Wohlschläger3,
  6. S Kars1,
  7. T Grimmer1,
  8. S Wagenpfeil4,
  9. A Monsch5,
  10. A Kurz1
  1. 1Department of Psychiatry and Psychotherapy, Technische Universität München, München, Germany
  2. 2Department of Nuclear Medicine, Technische Universität München
  3. 3Department of Neuroradiology, Technische Universität München
  4. 4Institute of Medical Statistics and Epidemiology, Technische Universität München
  5. 5Memory Clinic, Universitätsspital Basel, Basel, Switzerland
  1. Correspondence to:
 R Perneczky
 Psychiatrische Klinik der Technischen Universität München, Ismaningerstr. 22, 81675 München, Germany; robert.perneczky{at}


Background: Functional imaging studies report that higher education is associated with more severe pathology in patients with Alzheimer’s disease, controlling for disease severity. Therefore, schooling seems to provide brain reserve against neurodegeneration.

Objective: To provide further evidence for brain reserve in a large sample, using a sensitive technique for the indirect assessment of brain abnormality (18F-fluoro-deoxy-glucose-positron emission tomography (FDG-PET)), a comprehensive measure of global cognitive impairment to control for disease severity (total score of the Consortium to Establish a Registry for Alzheimer’s Disease Neuropsychological Battery) and an approach unbiased by predefined regions of interest for the statistical analysis (statistical parametric mapping (SPM)).

Methods: 93 patients with mild Alzheimer’s disease and 16 healthy controls underwent 18F-FDG-PET imaging of the brain. A linear regression analysis with education as independent and glucose utilisation as dependent variables, adjusted for global cognitive status and demographic variables, was conducted in SPM2.

Results: The regression analysis showed a marked inverse association between years of schooling and glucose metabolism in the posterior temporo-occipital association cortex and the precuneus in the left hemisphere.

Conclusions: In line with previous reports, the findings suggest that education is associated with brain reserve and that people with higher education can cope with brain damage for a longer time.

  • BRC, brain reserve capacity
  • CBF, cerebral blood flow
  • CERAD-NAB, Consortium to Establish a Registry for Alzheimer’s Disease Neuropsychological Battery
  • FDG-PET, fluoro-deoxy-glucose-positron emission tomography
  • MMSE, Mini-Mental State Examination
  • rCGMglc, regional cerebral metabolic rate of glucose utilisation
  • SPM, statistical parametric mapping

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  • Competing interests: None.

  • Published Online First 18 May 2006