Association Between Years of Education and Amyloid Burden in Patients With Subjective Cognitive Decline, MCI, and Alzheimer Disease

ObjectivesHigher-educated patients with Alzheimer disease (AD) can harbor greater neuropathologic burden than those with less education despite similar symptom severity.In this study, we assessed whether this observation is also present in potential preclinical AD stages, namely in individuals with subjective cognitive decline and clinical features increasing AD likelihood (SCD+). MethodsAmyloid-PET information ( 18 FFlutemetamol or 18 FFlorbetaben) of individuals with SCD+, mild cognitive impairment (MCI), and AD were retrieved from the AMYPAD-DPMS cohort, a multicenter randomized controlled study.Group classification was based on the recommendations by the SCD-I and NIA-AA working groups.Amyloid PET images were acquired within 8 months after initial screening and processed with AMYPYPE.Amyloid load was based on global Centiloid (CL) values.Educational level was indexed by formal schooling and subsequent higher education in years.Using linear regression analysis, the main effect of education on CL values was tested across the entire cohort, followed by the assessment of an education-by-diagnostic-group interaction (covariates: age, sex, and recruiting memory clinic).To account for influences of non-AD pathology and comorbidities concerning the tested amyloid-education association, we compared white matter hyperintensity (WMH) severity, cardiovascular events, depression, and anxiety history between lower-educated and highereducated groups within each diagnostic category using the Fisher exact test or χ 2 test.Education