Citation

Elbaz A, Vicente-Vytopilova P, Tavernier B, Sabia S, Dumurgier J, Mazoyer B, Singh-Manoux A, Tzourio C. Neurology 2013; 81(5): 417-426.

Affiliation

From INSERM (A.E., A.S.-M.), Centre for Research in Epidemiology and Population Health, U1018, Social and Occupational Determinants of Health, Villejuif; University of Versailles St.-Quentin (A.E., A.S.-M.), UMRS 1018, Villejuif; INSERM (P.V.-V., C.T.), U708, Neuroepidemiology, Paris and Bordeaux; CHU de Dijon (B.T.), Department of Geriatrics, Dijon, France; Department of Epidemiology and Public Health (A.E., S.S., A.S.-M.), University College London, UK; CMRR Paris Nord Ile-de-France (J.D.), Lariboisiere Fernand Widal Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Diderot, Paris; Groupe d'Imagerie Neurofonctionnelle (B.M.), UMR5296, CNRS, CEA, Université de Bordeaux, Bordeaux; Centre de Gérontologie (A.S.-M.), Hôpital Ste Périne, AP-HP, Paris; and Université Victor Segalen Bordeaux 2 (C.T.), Bordeaux, France.

Copyright

(Copyright © 2013, Lippincott Williams and Wilkins)

DOI

10.1212/WNL.0b013e31829d8761

PMID

23803317

Abstract

OBJECTIVE: The reserve hypothesis accounts for the lack of direct relationship between brain pathology and its clinical manifestations. Research has mostly focused on cognition; our objective is to examine whether the reserve hypothesis applies to motor function. We investigated whether education, a marker of reserve, modifies the association between white matter lesions (WMLs), a marker of vascular brain damage, and maximum walking speed (WS), an objective measure of motor function. We also examined the cross-sectional and longitudinal association between education and WS. METHODS: Data are from 4,010 participants aged 65-85 years in the longitudinal Three-City-Dijon Study with up to 4 WS measures over 10 years. We examined the interaction between education and WMLs for baseline WS. We studied the association between education and repeated WS measures using linear mixed models, and the role of covariates in explaining the education-WS association. RESULTS: Education was strongly associated with baseline WS; the difference in mean WS between the high and low education groups (0.145 m/s, 95% confidence interval = 0.125-0.165) was equivalent to 7.4 years of age. WMLs were associated with slow WS only in the low education group (p interaction = 0.026). WS declined significantly over time (-0.194 m/s/10 years, 95% confidence interval = -0.206, -0.182), but education did not influence rate of decline. Anthropometric characteristics, parental education, general health, and cognition had the strongest role in explaining the baseline education-WS association. CONCLUSIONS: Participants with more education were less susceptible to WMLs' effect on motor function. Higher education was associated with better motor performances but not with motor decline. These results are consistent with the passive reserve hypothesis.

Language: en