Beziehungen zwischen Demenz und dem Kopfumfang als Maß der Reservekapazität: Ergebnisse der Bayerischen Schulschwesternstudie

Zusammenfassung

Anliegen: Es wird der Frage nachgegangen, ob der Kopfumfang mit dem Vorkommen von Demenz und kognitiver Beeinträchtigung im Alter assoziiert ist. Methode: Querschnittstudie an den über 65-jährigen Mitgliedern einer religiösen Frauenkongregation, die ihr gesamtes Erwachsenenalter unter ähnlichen Umgebungsbedingungen verbracht haben. Ergebnisse: Ein geringerer Kopfumfang war signifikant mit höherer Demenzprävalenz sowie mit verminderter kognitiver Leistungsfähigkeit in Testverfahren und nach Fremdbeurteilung assoziiert. Schlussfolgerungen: Die Ergebnisse stützen die Hypothese, dass ein größeres Gehirn die Reservekapazität gegenüber kognitiven Beeinträchtigungen im Alter erhöht.

Abstract

Objective: The aim of the study was to examine the relationship of head circumference as a marker of maximal attained brain size to late-life cognitive impairment and dementia. Methods: Cognitive performance was assessed and the presence of dementia was diagnosed in a cross-sectional study of 442 Catholic sisters aged 65 years and over. Results: A head circumference below average was significantly associated with the presence of dementia even after adjustment for age, body mass index and presence of one or two apolipoproteine E ε4 alleles (OR = 2.0; 95 % CI: 1.1 - 3.6). The combination of small head circumference and apolipoprotein E ε4 strongly increased the risk of dementia (OR = 3.59; 95 % CI: 1.44 - 8.97). Conclusions: The findings support the hypothesis that a larger head size reduces the risk of cognitive decline and dementia in old age.

Literatur

• 1 Neuropathology Group of the Medical Research Council Cognitive Function and Ageing Study (MRC CFAS) . Pathological correlates of late-onset dementia in a multicentre, community-based population in England and Wales.  Lancet. 2001;  357 169-175
• 2 Stern Y. What is cognitive reserve? Theory and research application of the reserve concept.  J Int Neuropsychol Soc. 2002;  8 448-460
• 3 Katzman R, Terry R, Teresa R De, Brown T, Davies P, Fuld P, Renbing X, Peck A. Clinical, pathological, and neurochemical changes in dementia: A subgroup with preserved mental status and numerous neocortical plaques.  Ann Neurol. 1988;  23 138-144
• 4 Schofield P W, Logroscino G, Andrews H F, Albert S, Stern Y. An association between head circumference and Alzheimer's disease in a population-based study of aging and dementia.  Neurology. 1997;  49 30-37
• 5 Graves A B, Mortimer J A, Bowen J D, McCormick W C, McCurry S M, Schellenberg G D, Larson E B. Head circumference and incident Alzheimer's disease. Modification by apolipoprotein E.  Neurology. 2001;  57 1453-1460
• 6 Mortimer J A, Snowdon D A, Markesbery W R. Head circumference, education and risk of dementia: Findings from the Nun Study.  J Clin Exp Neuropsychol. 2003;  25 671-679
• 7 Wolf H, Julin P, Gertz H-J, Winblad B, Wahlund L-O. Intracranial volume in mild cognitive impairment, Alzheimer's disease and vascular dementia: evidence for brain reserve?.  Int J Geriat Psychiatry. 2004;  19 995-1007
• 8 Borenstein A R, Wu Y, Mortimer J A, Schellenberg G D, McCormick W C, Bowen J D, McCurry S, Larson E B. Developmental and vascular risk factors for Alzheimer's disease.  Neurobiol Aging. 2005;  26 325-334
• 9 Schofield P W, Mosesson R E, Stern Y, Mayeux R. The age at onset of Alzheimer's disease and an intracranial area measurement. A relationship.  Arch Neurol. 1995;  52 95-98
• 10 Reynolds M D, Johnston J M, Dodge H H, Kosky S T De, Ganguli M. Small head size is related to low Mini-Mental State Examination scores in a community sample of nondemented older adults.  Neurology. 1999;  53 228-229
• 11 Graves A B, Mortimer J A, Larson E B, Wenzlow A, Bowen J D, McCormick W C. Head circumference as a measure of cognitive reserve. Association with severity of impairment in Alzheimer's disease.  Br J Psychiatry. 1996;  169 86-92
• 12 Tisserand D J, Bosma H, Boxtel M PJ van, Jolles J. Head size and cognitive ability in nondemented older adults are related.  Neurology. 2001;  56 969-971
• 13 MacLullich A MJ, Ferguson K J, Deary I J, Seckl J R, Starr J M, Wardlaw J M. Intracranial capacity and brain volumes are associated with cognition in healthy elderly men.  Neurology. 2002;  59 169-174
• 14 Gale C R, Walton S, Martyn C N. Foetal and postnatal head growth and risk of cognitive decline in old age.  Brain. 2003;  126 2273-2278
• 15 Jenkins R, Fox N C, Rossor A M, Harvey R J, Rossor M N. Intracranial volume and Alzheimer disease. Evidence against the cerebral reserve hypothesis.  Arch Neurol. 2000;  57 220-224
• 16 Edland S D, Xu Y, Plevak M, O'Brien P, Tangalos E G, Petersen R C, Jack C R. Total intracranial volume: Normative values and lack of association with Alzheimer's disease.  Neurology. 2002;  59 272-274
• 17 McDaniel M A. Big-brained people are smarter: A meta-analysis of the relationship between in vivo brain volume and intelligence.  Intelligence. 2005;  33 337-346
• 18 Hack M, Breslau N, Weissman B, Aram D, Klein N, Borawski E. Effect of very low birth weight and subnormal head size on cognitive abilities at school age.  N Engl J Med. 1991;  325 231-237
• 19 Cooke R WI, Foulder-Hughes L. Growth impairment in the very preterm and cognitive and motor performance at 7 years.  Arch Dis Child. 2003;  88 482-487
• 20 Gale C R, O'Callaghan F J, Godfrey K M, Law C M, Martyn C N. Critical periods of brain growth and cognitive function in children.  Brain. 2004;  127 321-329
• 21 Morris J C, Heyman A, Mohs R C, Hughes J P, Bele G van, Fillenbaum G, Mellits E D, Clark C. The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer's disease.  Neurology. 1989;  39 1159-1165
• 22 Folstein M F, Folstein S E, McHugh P R. „Mini-Mental State”. A practical method for grading the cognitive state of patients for the clinician.  J Psychiat Res. 1975;  12 189-198
• 23 Lehrl S. Manual zum MWT-B. Erlangen; peri-med-Verlag 1977
• 24 Sheikh J I, Yesavage J A. Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. In: Brink TL Clinical gerontology: A guide to assessment and intervention. New York; Haworth Press 1986: 165-173
• 25 Erzigkeit H, Lehfeld H, Pena-Casanova J, Bieber F, Yekrangi-Hartmann C, Rupp M, Rappard F, Arnold K, Hindmarch I. The Bayer-Activities of Daily Living Scale (B-ADL): results from a validation study in three European countries.  Dement Geriatr Cogn Disord. 2001;  12 348-358
• 26 Jorm A F. A short form of the informant questionnaire on cognitive decline in the elderly (IQCODE): development and cross-validation.  Psychol Med. 1994;  24 145-153
• 27 Hughes C P, Berg L, Danziger W L, Coben L A, Martin R L. A new clinical scale for the staging of dementia.  Br J Psychiatry. 1982;  140 566-572
• 28 McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan E M. Clinical diagnosis of Alzheimer's disease: Report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's disease.  Neurology. 1984;  34 939-943
• 29 Roman G C, Tatemichi T K, Erkinjuntti T. et al . Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop.  Neurology. 1993;  43 250-260
• 30 Wolf H, Kruggel F, Hensel A, Wahlund L-O, Arendt T, Gertz H-J. The relationship between head size and intracranial volume in elderly subjects.  Brain Research. 2003;  973 74-80
• 31 Epstein H T, Epstein E B. The relationship between brain weight and head circumference from birth to age 18 years.  Am J Phys Anthropol. 1978;  48 471-473
• 32 Strathearn L, Gray P H, O'Callaghan F, Wood D O. Childhood neglect and cognitive development in extremely low birth weight infants: a prospective study.  Pediatrics. 2001;  108 142-151
• 33 Riedel-Heller S G. Das Spektrum psychischer Störungen im Alter - eine Bevölkerungsperspektive.  Psychiat Prax. 2004;  31 327-329