Journal Article DZNE-2026-00866

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Educational attainment and sex modulate clinical outcomes in genetic frontotemporal dementia.

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2026
Oxford University Press [Oxford]

Brain communications 8(4), fcag262 () [10.1093/braincomms/fcag262]

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Abstract: Individuals with autosomal dominant frontotemporal dementia (FTD) exhibit considerable variability in disease onset and progression. Both modifiable and non-modifiable factors-such as sex, educational attainment or geographic region of residence-may contribute to this heterogeneity, potentially through their influence on cognitive reserve. The aim of the present study was to investigate the role of cognitive reserve modulators within the Genetic Frontotemporal dementia Initiative (GENFI) cohort. To this end, we used functional MRI (i.e. spatial chronnectome measures) and neurodegenerative markers (i.e. plasma neurofilament light chains levels) to determine disease stage using a Discriminative Event-Based Model (DEBM). We then examined how potential modulators influence the relationship between disease stage and cognitive performance. We analysed a total of 711 participants, including 106 patients with genetic FTD, 325 presymptomatic mutation carriers and 280 non-carriers healthy controls. Female participants showed a weaker association between disease stage and cognitive performance compared to males (P < 0.001), with difference becoming progressively more pronounced across symptomatic stages. Educational attainment exhibited a similar effect: individuals with higher education demonstrated an attenuated association compared to those with secondary or primary schooling (P < 0.001), with differences already detectable at prodromal disease stages. The effect of geographical region of residence was associated with education levels, but appeared to have an indirect and less strong influence. In summary, sex and educational attainment significantly affect the development and maintenance of cognitive reserve in individuals with genetic FTD. These findings underscore the importance of identifying disease-modifying interventions since the presymptomatic stages of the disease.

Keyword(s): Discriminative Event-Based Model (DEBM) ; education ; frontotemporal lobar degeneration ; genetic ; sex

Classification:

Contributing Institute(s):
  1. Clinical Research (Munich) (Clinical Research (Munich))
  2. Clinical Neurodegeneration (AG Levin)
  3. Parkinson Genetics (AG Gasser)
Research Program(s):
  1. 353 - Clinical and Health Care Research (POF4-353) (POF4-353)

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Medline ; Creative Commons Attribution CC BY 4.0 ; DOAJ ; OpenAccess ; Article Processing Charges ; Clarivate Analytics Master Journal List ; DOAJ Seal ; Emerging Sources Citation Index ; Fees ; IF < 5 ; JCR ; SCOPUS ; Web of Science Core Collection
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Institute Collections > M DZNE > M DZNE-Clinical Research (Munich)
Document types > Articles > Journal Article
Institute Collections > TÜ DZNE > TÜ DZNE-AG Gasser
Institute Collections > M DZNE > M DZNE-AG Levin
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 Record created 2026-08-05, last modified 2026-08-06


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