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Influence of Education on Subcortical Hyperintensities and Global Cognitive Status in Vascular Dementia

  • Elizabeth M. Lane (a1), Robert H. Paul (a1), David J. Moser (a2), Thomas D. Fletcher (a1) and Ronald A. Cohen (a3)...


Subcortical hyperintensities (SH) on neuroimaging are a prominent feature of vascular dementia (VaD) and SH severity correlates with cognitive impairment in this population. Previous studies demonstrated that SH burden accounts for a degree of the cognitive burden among VaD patients, although it remains unclear if individual factors such as cognitive reserve influence cognitive status in VaD. To address this issue, we examined 36 individuals diagnosed with probable VaD (age = 77.56; education = 12). All individuals underwent MMSE evaluations and MRI brain scans. We predicted that individuals with higher educational attainment would exhibit less cognitive difficulty despite similar levels of SH volume, compared to individuals with less educational attainment. A regression analysis revealed that greater SH volume was associated with lower scores on the MMSE. Additionally, education moderated the relationship between SH volume and MMSE score, demonstrating that individuals with higher education had higher scores on the MMSE despite similar degrees of SH burden. These results suggest that educational attainment buffers the deleterious effects of SH burden on cognitive status among VaD patients. (JINS, 2011, 17, 531–536)


Corresponding author

Correspondence and reprint requests to: Elizabeth M. Lane, Department of Psychology, University of Missouri – Saint Louis, Saint Louis, MO 63121. E-mail:


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Aiken, L.S., West, S.G. (1991). Multiple regression: Testing and interactions. Newbury Park, CA: Sage.
Bieliauskas, L.A., Back-Madruga, C., Lindsay, K.L., Wright, E.C., Kronfol, Z., Lok, A.S.F., The Halt-C Trial Group (2007). Cognitive reserve and neuropsychological functioning in patients infected with Hepatitis C. Journal of the International Neuropsychological Society, 13(4), 687692.
Bombois, S., Debette, S., Delbeuck, X., Bruandet, A., Lepoittevin, S., Delmaire, C., Pasquier, F. (2007). Prevalence of subcortical vascular lesions and association with executive function in mild cognitive impairment subtypes. Stroke, 38, 25952597.
Boyle, P.A., Paul, R.H., Moser, D.J., Cohen, R.A. (2004). Executive impairments predict functional declines in vascular dementia. The Clinical Neuropsychologist, 18(1), 7582.
Cohen, J., Cohen, P., West, S.G., Aiken, L.S. (2003). Applied multiple regression/correlation analysis for the behavioral sciences (3rd ed.). Hillsdale: Erlbaum.
Cohen, R.A., Browndyke, J.N., Moser, D.J., Paul, R.H., Gordon, N., Sweet, L. (2003). Long-term Citicoline (Cytidine Diphosphate Choline) use in patients with vascular dementia: Neuroimaging and neuropsychological outcomes. Cerebrovascular Diseases, 16, 199204.
Cohen, R.A., Paul, R.H., Ott, B.R., Moser, D.J., Zawacki, T.M., Stone, W., Gordon, N. (2002). The relationship of subcortical MRI hyperintensities and brain volume to cognitive function in vascular dementia. Journal of the International Neuropsychological Society, 8, 743752.
Davison, A.C., Hinkley, D.V. (1999). Bootstrap methods and their application. London: Cambridge University Press.
Del Ser, T., Hachinski, V., Merskey, H., Munoz, D.G. (1999). An autopsy-verified study of the effect of education on degenerative dementia. Brain, 122, 23092319.
Di Iorio, A., Zito, M., Lupinetti, M., Abate, G. (1999). Are vascular factors involved in Alzheimer's disease? Facts and theories. Aging Clinical and Experimental Research, 11, 345352.
Dufouil, C., Alperovitch, A., Tzourio, C. (2003). Influence of education on the relationship between white matter lesions and cognition. Neurology, 60, 831836.
Efron, B., Tibshirani, R. (1993). An introduction to the bootstrap. New York: Chapman & Hall.
Evans, M.G. (1985). A Monte-Carlo study of the effects of correlated method variance in moderated multiple regression analysis. Organizational Behavior and Human Decision Processes, 36, 305323.
Fischer, P., Krampla, W., Mostafaie, N., Zehetmayer, S., Rainer, M., Jungworth, S., Tragl, K.H. (2007). VITA study: White matter hyperintensities of vascular and degenerative origin in the elderly. Journal of Neural Transmission, Supplement, 72, 181188.
Fratiglioni, L., Paillard-Borg, S., Winblad, B. (2004). An active and socially integrated lifestyle in late life might protect against dementia. Lancet Neurology, 3, 343353.
Garrett, K.D., Cohen, R.A., Paul, R.H., Moser, D.J., Malloy, P.F., Shah, P., Haque, O. (2004). Computer-mediated measurement and subjective ratings of white matter hyperintensities in vascular dementia: Relationships to neuropsychological performance. The Clinical Neuropsychologist, 18(1), 5062.
Graham, N.L., Emery, T., Hodges, J.R. (2004). Distinctive cognitive profiles in Alzheimer's disease and subcortical vascular dementia. Journal of Neurology, Neurosurgery, and Psychiatry, 75, 6171.
Helzner, E.P., Scarmeas, N., Cosentino, S., Portet, F., Stern, Y. (2007). Leisure activity and cognitive decline in incident Alzheimer disease. Archives of Neurology, 64(12), 17491754.
Jellinger, K.A. (2003). Is Alzheimer's disease a vascular disorder? Journal of Alzheimer's Disease, 5, 247250.
Jellinger, K.A., Attems, J. (2003). Incidence of cerebrovascular lesions in Alzheimer's disease: A postmortem study. Acta Neuropathologica, 105, 1417.
Jokinen, H., Kalska, H., Mantyla, R., Pohjasvaara, T., Ylikoski, R., Hietanen, M., Erkinjuntti, T. (2006). Cognitive profile of subcortical ischaemic vascular disease. Journal of Neurology, Neurosurgery, and Psychiatry, 77, 2833.
Jokinen, H., Kalska, H., Mantyla, R., Ylikoski, R., Heitanen, M., Pohjasvaara, T., Erkinjuntti, T. (2005). White matter hyperintensities as a predictor of neuropsychological deficits post-stroke. Journal of Neurology, Neurosurgery, and Psychiatry, 76, 12291233.
Kaplan, R.F., Cohen, R.A., Muscufo, N., Guttmann, C., Chasman, J., Buttaro, M., Wolfson, L. (2009). Demographic and biological influences on cognitive reserve. Journal of Clinical and Experimental Neuropsychology, 31(7), 868876. doi:10.1080/13803390802635174
Kertesz, A., Clydesdale, S. (1994). Neuropsychological deficits in vascular dementia vs Alzheimer's disease: Frontal lobe deficits in vascular dementia. Archives of Neurology, 51, 12261231.
Kesler, S.R., Adams, H.F., Blasey, C.M., Bigler, E.D. (2003). Premorbid intellectual functioning, education, and brain size in traumatic brain injury: An investigation of the cognitive reserve hypothesis. Applied Neuropsychology, 10(3), 153162.
McDowell, I., Xi, G., Lindsay, J., Teirney, M. (2007). Mapping the connections between education and dementia. Journal of Clinical and Experimental Neuropsychology, 29(2), 127141.
McGurn, B., Deary, I.J., Starr, J.M. (2008). Childhood cognitive ability and risk of late-onset Alzheimer and vascular dementia. Neurology, 71, 10511056.
Mortimer, J.A., Snowdon, D.A., Markesbery, W.R. (2003). Head circumference, education and risk of dementia: Findings from the Nun Study. Journal of Clinical and Experimental Neuropsychology, 25(5), 671679.
Nebes, R.D., Meltzer, C.C., Whyte, E.M., Scanlon, J.M., Halligan, E.M., Saxton, J.A., DeKosky, S.T. (2006). The relation of white matter hyperintensities to cognitive performance in the normal old: Education matters. Aging, Neuropsychology, and Cognition, 13, 326340.
Paul, R.H., Garrett, K., Cohen, R. (2003). Vascular dementia: A diagnostic conundrum for the clinical neuropsychologist. Applied Neuropsychology, 10(3), 129136.
Paul, R.H., Haque, O., Gunstad, J., Tate, D.F., Grieve, S.M., Hoth, K., Gordon, E. (2005). Subcortical hyperintensities impact cognitive function among a select subset of healthy elderly. Archives of Clinical Neuropsychology, 20, 697704.
Riley, K.P., Snowdon, D.A., Desrosiers, M.F., Markesbery, W.R. (2005). Early life linguistic ability, late life cognitive function, and neuropathology: Findings from the Nun Study. Neurobiology of Aging, 26, 341347.
Roman, G.C., Erkinjuntti, T., Wallin, A., Pantoni, L., Chui, H.C. (2002). Subcortical ischaeic vascular dementia. Lancet Neurology, 1, 426436.
Roselli, F., Tartaglione, B., Federico, F., Lepore, V., Defazio, G., Livrea, P. (2009). Rate of MMSE score change in Alzheimer's disease: Influence of education and vascular risk factors. Clinical Neurology and Neurosurgery, 111, 327330.
Scarmeas, N., Albert, S.M., Manly, J.J., Stern, Y. (2006). Education and rates of cognitive decline in incident Alzheimer's disease. Journal of Neurology, Neurosurgery, and Psychiatry, 77, 308316.
Scarmeas, N., Stern, Y. (2003). Cognitive reserve and lifestyle. Journal of Clinical and Experimental Neuropsychology, 25(5), 625633.
Schmidt, R., Fazekas, F., Offenbacher, H., Dusek, T., Zach, E., Grieshofer, R.P., Lechner, H. (1993). Neuropsychological correlates of MRI white matter hyperintensities: A study of 150 normal volunteers. Neurology, 43, 24902494.
Snowdon, D.A., Kemper, S.J., Mortimer, J.A., Greiner, L.H., Wekstein, D.R., Markesbery, W.R. (1996). Linguistic ability in early life and cognitive function and Alzheimer's disease in late life: Findings from the Nun Study. Journal of the American Medical Association, 275(7), 528532.
Sole-Padulles, C., Bartres-Faz, D., Junque, C., Vendrell, P., Rami, L., Clemente, I.C., Molinuevo, J.L. (2009). Brain structure and function related to cognitive reserve variables in normal aging, mild cognitive impairment and Alzheimer's disease. Neurobiology of Aging, 30, 11141124.
Stern, Y. (2002). What is cognitive reserve? Theory and research application of the reserve concept. Journal of the International Neuropsychological Society, 8, 448460.
Stern, Y. (2006). Cognitive reserve and Alzheimer disease. Alzheimer Disease and Associated Disorders, 20, S69S74.
Stern, Y. (2009). Cognitive reserve. Neuropsychologia, 47, 20152028.
Stern, Y., Habeck, C., Moeller, J., Scarmeas, N., Anderson, K.E., Hilton, H.J., van Heertum, R. (2005). Brain networks associated with cognitive reserve in healthy young and old adults. Cerebral Cortex, 15, 394402. doi:10.1093/cercor/bhh142
Tierney, M.C., Black, S.E., Szalat, J.P., Snow, G., Fisher, R.H., Nadon, G., Chui, H. (2001). Recognition memory and verbal fluency differentiate probable Alzheimer's disease from subcortical ischemic vascular dementia. Archives of Neurology, 58, 16541659.
Traykov, L., Baudic, S., Raoux, N., Latour, F., Rieu, D., Smagghe, A., Rigaud, A.S. (2005). Patterns of memory impairment and perseverative behavior discriminate early Alzheimer's disease from subcortical vascular dementia. Journal of the Neurological Sciences, 229–230, 7579.
Wallin, A. (1998). The overlap between Alzheimer's disease and vascular dementia: The role of white matter changes. Dementia and Geriatric Cognitive Disorders, 9(Suppl. 1), 3035.
Warlaw, J.M., Sandercock, P.A.G., Dennis, M.S., Starr, J. (2003). Is breakdown of the blood-brain barrier responsible for lacunar stroke, leukaraiosis, and dementia? Stroke, 34(3), 806812.
Wilson, R.S., Hebert, L.E., Scherr, P.A., Barnes, L.L., Mendes de Leon, C.F., Evans, D.A. (2009). Educational attainment and cognitive decline in old age. Neurology, 72, 460465.
Wolf, H., Julin, P., Gertz, H.J., Winblad, B., Wahlund, L.O. (2004). Intracranial volume in mild cognitive impairment, Alzheimer's disease and vascular dementia: Evidence for brain reserve? International Journal of Geriatric Psychiatry, 19, 9951007.


Influence of Education on Subcortical Hyperintensities and Global Cognitive Status in Vascular Dementia

  • Elizabeth M. Lane (a1), Robert H. Paul (a1), David J. Moser (a2), Thomas D. Fletcher (a1) and Ronald A. Cohen (a3)...


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