Skip to main content Accessibility help
×
Home

Head Circumference as a Measure of Cognitive Reserve: Association with Severity of Impairment in Alzheimer's Disease

  • A. B. Graves (a1), J. A. Mortimer (a2), E. B. Larson (a3), A. Wenzlow (a4), J. D. Bowen (a5) and W. C. McCormick (a6)...

Abstract

Background

Recent studies suggest that larger brain size may offer some protection against the clinical manifestations of Alzheimer's disease. However, this association has not been investigated in population-based studies.

Method

The relationship between head circumference, a measure of premorbid brain size, and score on the Cognitive Abilities Screening Instrument (CASI) was studied in a population of 1985 Japanese–Americans aged 65+ living in King County, Washington, USA.

Results

After adjusting for age, sex and education, head circumference was positively associated with CASI score (b=3.8, 95% CI: 2.2, 5.4; P=0.0000), but not with diagnosis of probable AD (odds ratio=0.87, 95% CI: 0.33, 1.87). When the data were stratified by AD status, no association was seen among controls (b=1.6, 95% CI: – 1.7, 5.1; P=0.4), whereas a strong effect was present among cases (b=35.3, 95% CI: 12.2, 58.4: P=0.006).

Conclusions

These results suggest that persons with AD with smaller head circumference either had the disease longer or progressed more rapidly than those with larger head circumference. Improvement in environmental factors in prenatal and early life that partially determine completed brain/head size may have consequences for the late-life expression of Alzheimer's disease in vulnerable individuals.

Copyright

Corresponding author

Amy B. Graves, Department of Epidemiology and Biostatistics, College of Public Health, MDC-56, University of South Florida, 13201 Bruce B. Downs Blvd., Tampa, FL 33612-3805, USA

References

Hide All
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) DSM–III–R. Washington, DC: APA.
Andreasen, N. C., Flaum, M., Swayze, V. II., et al (1993) Intelligence and brain structure in normal individuals. American Journal of Psychiatry, 150, 130134.
Brandt, I. (1978) Growth dynamics of low-birth weight infants with emphasis on the perinatal period. In Human Growth. Volume 2 (eds Faulkner, F. & Tanner, J. M.), pp. 469518. New York: Plenum Press.
Cameron, N. (1978) The methods of auxological anthropometry. In: Human Growth, Volume 2: Postnatal Growth (eds Falkner, F. & Tanner, J. M.), pp. 3590. New York: Plenum Press.
Dobbing, J. & Sands, J. (1973) Quantitative growth and development of human brain. Archives of Diseases in Childhood, 49, 757767.
Elo, I. T. & Preston, S. H. (1992) Effects of early-life conditions on adult mortality: a review. Population Index, 58, 186212.
Emanuel, I. (1993) Intergenerational factors in pregnancy outcome: implications for teratology? In Issues and Reviews in Teratology, Volume 6 (ed. Kaltner, H.), pp. 4784. New York: Plenum Press.
Epstein, H. T. (1979) Correlated brain and intelligence development in humans. In Development and Evolution of Brain Size (eds Hahn, M. E., Jensen, C. & Dudek, B. C.), pp. 111131. New York: Academic Press.
Evans, D. A., Smith, L. A., Albert, M. S., et al (1993) Level of education and change in cognitive function in a community population of older persons. Annals of Epidemiology, 3, 7177.
Folstein, M. F., Folstein, S. E. & McHugh, P. R. (1975). “Mini-Mental State”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Förstl, H., Burns, A., Jacoby, R., et al (1991) Quantitative CT scan analysis in senile dementia of the Alzheimer type: I. Computerized planimetry of cerebrospinal fluid areas. International Journal of Geriatric Psychiatry, 6, 709713.
Graves, A. B., Larson, E. B., Edland, S., et al (1995) Prevalence of dementia and its subtypes in a total population of older Japanese Americans in King County, WA. Abstract Neurology, 45 (suppl 4), A216.
Hack, M., Breslau, N., Weissman, B., et al (1991) Effect of very low birth weight and subnormal head size on cognitive abilities at school age. New England Journal of Medicine, 325, 231237.
Hasegawa, K. (1983) The clinical assessment of dementia in the aged: a dementia screening scale for psychogeriatric patients. In: Aging in the Eighties and Beyond (eds Bergener, M., Lehr, U., Lang, E., et al), pp. 207218. New York: Springer.
Hosmer, D. W. & Lemeshow, S. (1989) Applied Logistic Regression, New York: Wiley.
Hughes, C. P., Berg, L., Danziger, W. L., et al (1982) A new clinical scale for the staging of dementia. British Journal of Psychiatry, 146, 566572.
Jensen, A. R. & Sinha, S. N. (1993) Physical correlates of human intelligence. In Biological Approaches to the Study of Human Intelligence (ed. Vernon, P. A.), pp. 139242. Norwood, New Jersey: Ablex Publishing Corporation.
Katzman, R., Terry, R., DeTeresa, R., et al (1988) Clinical, pathological and neurochemical changes in dementia: a subgroup with preserved mental status and numerous neocortical plaques. Annals of Neurology, 23, 138144.
Larson, E. B., Kukull, W. A., Teri, L., et al (1990) University of Washington Alzheimer's Disease Patient Registry: 1987–1988. Aging, 2, 404408.
Lynn, R. (1989) A nutrition theory of the secular increases in intelligence, positive correlations between height, head size and IQ. British Journal of Educational Psychology, 59, 372377.
Martorell, R. & Habicht, J. P. (1986) Growth in early childhood in developing countries. In Human Growth: A Comprehensive Treatise, 2nd edition. Volume 3: Methodology, Ecological, Genetic and Nutritional Effects on Growth (eds Falkner, F. & Tanner, J. M.), pp. 241262. New York: Plenum Press.
McKhann, G., Drachmann, D., Folstein, M. F., et al (1984) 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, 34, 939944.
Miller, A. K. H. & Corsellis, J. A. N. (1977) Evidence for a secular increase in human brain weight during the past century. Annals of Human Biology, 4, 253257.
Mortimer, J. A. & Graves, A. B. (1993) Education and other socioeconomic determinants of dementia and Alzheimer's disease. Neurology, 43 (Suppl. 4), S39S44.
Norusis, M. J. (1986) SPSS/PC+ for the IBM PC/XT/AT. Chicago, Ill: SPSS Inc.
SAS/STAT User's Guide (1990) Version 6, Fourth Edition. Cary, NC: SAS Institute, Inc.
Schofield, P. W., Mosesson, R. E., Stern, Y., et al (1995) The age at onset of Alzheimer's disease and an intracranial area measurement Archives of Neurology, 52, 9598.
Sells, C. J. (1977) Microcephaly in a normal school population. Pediatrics, 59, 262265.
Stern, Y., Gurland, B., Tatemichi, T., et al (1994) Influence of education and occupation on the incidence of Alzheimer's disease. Journal of the American Medical Association, 271, 10041010.
Teng, B. L. & Chui, H. C. (1987) The Modified Mini-Mental State (3MS) examination. Journal of Clinical Psychiatry, 48, 314318.
Teng, B. L., Hasegawa, K., Homma, A., et al (1994) The Cognitive Abilities Screening Instrument (CASI): a practical test for cross-cultural epidemiologic studies of dementia. International Psychogeriatrics, 6, 4556.
Teri, L., McCurry, S. M., Edland, S. D., et al (1995) Cognitive decline in Alzheimer's disease: a longitudinal investigation of risk factors for accelerated decline. Journal of Gerontology, 50A, M49M55.
Tomlinson, B. E., Blessed, G. & Roth, M. (1968) Observations on the brains of nondemented old people. Journal of Neurological Science, 7, 331356.
Van Valen, L. (1974) Brain size and intelligence in man. American Journal of Physical Anthropology, 40, 417424.
Zar, J. H. (1984) Biostatistical Analysis, 2nd edition. New Jersey: Prentice Hall.
Zhang, M. Y., Katzman, R., Salmon, D., et al (1990) The prevalence of dementia and Alzheimer's disease in Shanghai, China: impact of age, gender and education. Annals of Neurology, 27, 428437.

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Head Circumference as a Measure of Cognitive Reserve: Association with Severity of Impairment in Alzheimer's Disease

  • A. B. Graves (a1), J. A. Mortimer (a2), E. B. Larson (a3), A. Wenzlow (a4), J. D. Bowen (a5) and W. C. McCormick (a6)...
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *