Raul Gonzalez-Gomez, Josephine Cruzat, Hernán Hernández, Joaquín Migeot, Agustina Legaz, Hernando Santamaria-García, Sol Fittipaldi, Marcelo Adrián Maito, Vicente Medel, Enzo Tagliazucchi, Pablo Barttfeld, Daniel Franco-O'Byrne, Ana María Castro Laguardia, Patricio A Borquez, José Alberto Avila-Funes, María I Behrens, Nilton Custodio, Temitope Farombi, Adolfo M García, Indira Garcia-Cordero, Maria E Godoy, Cecilia Gonzalez Campo, Kun Hu, Brian Lawlor, Diana L Matallana, Bruce Miller, Maira Okada de Oliveira, Stefanie D Pina-Escudero, Elisa de Paula França Resende, Pablo Reyes, Andrea Slachevsky, Leonel T Takada, Görsev G Yener, Carlos Coronel-Oliveros, Agustin Ibañez
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引用次数: 0
摘要
背景：虽然教育对大脑健康至关重要，但证据主要依赖于个人受教育年数（YoE），而忽视了教育质量（EQ）。YoE和EQ对衰老和痴呆的影响尚未进行比较。方法：我们对来自20个国家的7533名受试者进行了情商和YoE对大脑健康的影响的横断面评估，包括健康对照组（hc）、阿尔茨海默病（AD）和额颞叶变性（FTLD）。情商是基于国际学生评估项目（PISA）提供的国家级质量指标。在应用神经图像协调后，我们检查了其与YoE一起对灰质体积和功能连接的影响。回归模型根据年龄、性别和认知进行调整，控制多重比较。通过灵敏度分析评估图像质量的影响。数据收集时间为2024年6月1日至10月30日。研究发现：低情商和低情商与各组大脑变化有关。然而，情商的影响更大，主要针对每种情况的关键区域。在全脑水平上，EQ影响体积(hc： Δmean = 2.0 [1.9 - 2.0] × 10-2, p -5；AD： Δmean = 0·1[-0·0 ~ 0·3]× 10-2, p = 0.18；FTLD： Δmean = 3.5[3·0-4·0]× 10-2, p -5；均有95%置信区间)和网络(hc： Δmean = 13.5 [13.2 - 13.7] × 10-2, p -5；AD： Δmean = 5.9 [5.2 - 6.7] × 10-2, p -5；FTLD： Δmean = 13·2[11·2-13·7]× 10-2, p -5)是YoE的1·3 ~ 7·0倍。尽管国家和个人的收入和社会经济因素存在差异，但这些影响仍然强劲。解释：研究结果支持将教育质量纳入学习和改善大脑健康的必要性，强调了国家层面措施的重要性。资助：扩大拉丁美洲痴呆症研究的多伙伴联盟（redlate）。
Qualitative and quantitative educational disparities and brain signatures in healthy aging and dementia across global settings.
Background: While education is crucial for brain health, evidence mainly relies on individual measures of years of education (YoE), neglecting education quality (EQ). The effect of YoE and EQ on aging and dementia has not been compared.
Methods: We conducted a cross-sectional assessment of the effect of EQ and YoE on brain health in 7533 subjects from 20 countries, including healthy controls (HCs), Alzheimer's disease (AD), and frontotemporal lobar degeneration (FTLD). EQ was based on country-level quality indicators provided by the programme for international student assessment (PISA). After applying neuroimage harmonization, we examined its effect, along with YoE, on gray matter volume and functional connectivity. Regression models were adjusted for age, sex, and cognition, controlling for multiple comparisons. The influence of image quality was assessed through sensitivity analysis. Data collection was conducted between June 1 and October 30, 2024.
Findings: Less EQ and YoE were associated with brain alterations across groups. However, EQ had a stronger influence, mainly targeting the critical areas of each condition. At the whole-brain level, EQ influenced volume (HCs: Δmean = 2·0 [1·9-2·0] × 10-2, p < 10-5; AD: Δmean = 0·1 [-0·0 to 0·3] × 10-2, p = 0·18; FTLD: Δmean = 3·5 [3·0-4·0] × 10-2, p < 10-5; all with 95% confidence intervals) and networks (HCs: Δmean = 13·5 [13·2-13·7] × 10-2, p < 10-5; AD: Δmean = 5·9 [5·2-6·7] × 10-2, p < 10-5; FTLD: Δmean = 13·2 [11·2-13·7] × 10-2, p < 10-5) 1·3 to 7·0 times more than YoE. These effects remain robust despite variations in income and socioeconomic factors at country and individual levels.
Interpretation: The results support the need to incorporate education quality into studying and improving brain health, underscoring the importance of country-level measures.
Funding: Multi-partner consortium to expand dementia research in Latin America (ReDLat).
期刊介绍：
eClinicalMedicine is a gold open-access clinical journal designed to support frontline health professionals in addressing the complex and rapid health transitions affecting societies globally. The journal aims to assist practitioners in overcoming healthcare challenges across diverse communities, spanning diagnosis, treatment, prevention, and health promotion. Integrating disciplines from various specialties and life stages, it seeks to enhance health systems as fundamental institutions within societies. With a forward-thinking approach, eClinicalMedicine aims to redefine the future of healthcare.
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