Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Original Research Article Dement Geriatr Cogn Disord 2005;20:8–14 DOI: 10.1159/000085068 Cognitive Reserve: A SPECT Study of 132 Alzheimer’s Disease Patients with an Education Range of 0–19 Years Yi-Chu Liao a, c, f Ren-Shyan Liu d Evenly Lee Teng h Yi-Chung Lee a, b, g Pei-Ning Wang a, c Ker-Neng Lin c, e Chih-Ping Chung a, c Hsiu-Chih Liu a, c a Department of Neurology and b Institute of Clinical Medicine, National Yang-Ming University School of Medicine, c Neurological Institute and d Department of Nuclear Medicine, Taipei Veterans General Hospital, and e Department of Psychology, Fu Jen Catholic University, Taipei, f Department of Neurology, E-Da Hospital and I-Shou University, Kaohsiung, and g Department of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan; h Department of Neurology, University of Southern California Keck School of Medicine, Los Angeles, Calif., USA tween education and cognitive test scores. Years of for- mal schooling had negative associations with cerebral perfusion and positive associations with cognitive test scores. The brain regions showing a significant educa- tion effect on perfusion involved bilateral posterior as- sociation areas in mild dementia, and bilateral parieto- temporo-frontal areas in moderate dementia. The present findings indicate that the cognitive reserve effect starts at the low end of the education range. They also suggest that the main effect of more education is a more facile use of alternative brain circuits instead of locally increased synaptic connections. Copyright © 2005 S. Karger AG, Basel Introduction Little or no formal education is an important risk fac- tor for dementia including Alzheimer’s disease (AD) [1– 3] , and a ‘cognitive reserve’ hypothesis has been proposed to account for this phenomenon. In essence, this hypoth- esis suggests that more schooling, together with its associ- Key Words Alzheimer’s disease  Cognitive reserve  Education  Single photon emission computed tomography  Statistical parametric mapping Abstract This study examines the associations between educa- tion, cerebral perfusion, and cognitive test performance among 132 patients with Alzheimer’s disease. The par- ticipants had had between 0 and 19 years of formal schooling, and had either mild or moderate dementia according to the Clinical Dementia Rating Scale. Cerebral perfusion was evaluated by the 99m Tc-hexamethylpro- pylene amine oxime single photon emission computed tomography. The Mini-Mental State Examination and the Cognitive Abilities Screening Instrument were used to assess cognitive performance. For patients at each clinical dementia severity level, statistical parametric mapping was used to examine voxel by voxel the asso- ciation between education and cerebral perfusion, and Pearson’s correlation coefficients were calculated be- Accepted: November 24, 2004 Published online: April 12, 2005 Dr. Hsiu-Chih Liu The Neurological Institute, Taipei Veterans General Hospital 201 Sec. 2, Shih-pai Road, Shih-pai Taipei 11217 (Taiwan) Tel. +886 2 2875 7492, Fax +886 2 2873 8696, E-Mail hcliu@vghtpe.gov.tw © 2005 S. Karger AG, Basel 1420–8008/05/0201–0008$22.00/0 Accessible online at: www.karger.com/dem