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Published on: December 18, 2016
Influence of Cognitive Reserve on Cognitive Trajectories: Role of Brain Pathologies
Xuerui Li1, Ruixue Song2, Xiuying Qi2
1From the Department of Epidemiology and Biostatistics (X.L., R.S., X.Q., W.Y., W.X.), School of Public Health, Tianjin Medical University; Tianjin Key Laboratory of Environment, Nutrition and Public Health (X.L., R.S., X.Q., W.Y., W.X.); Center for International Collaborative Research on Environment, Nutrition and Public Health (X.L., R.S., X.Q., W.Y., W.X.), Tianjin; Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine (R.S.), Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan; Big Data and Engineering Research Center (H.X.), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China; Division of Clinical Geriatrics, Center for Alzheimer Research (M.K.), and Aging Research Center (W.X.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet; Theme Aging (M.K.), Karolinska University Hospital, Stockholm, Sweden; Ageing and Epidemiology (AGE) Research Unit (M.K.), School of Public Health, Imperial College London, UK; and Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL. weili.xu@ki.se qixiuying@tmu.edu.cn.
Background And Objectives:
Evidence on the association of cognitive reserve (CR) with the cognitive trajectories is limited. We aimed to examine the influence of CR indicator on domain-specific cognitive trajectories taking brain pathologies into account.
Methods:
Within the Rush Memory and Aging Project, 1,697 participants without dementia (mean age 79.6 years) were followed up to 21 years. CR indicator encompassing education, early-life, mid-life, and late-life cognitive activities and late-life social activity was ascertained at baseline and categorized as tertiles (lowest, middle, and highest). Global cognition, episodic memory, semantic memory, working memory, visuospatial ability, and perceptual speed were assessed annually with 19 tests, from which composite scores were derived. During the follow-up, 648 participants died and underwent autopsies to evaluate brain pathologies. Data were analyzed using linear mixed-effect models.
Results:
Among the participants, the score of the CR indicator ranged from -8.00 to 5.74 (mean 0.00 ± 2.23). In multi-adjusted mixed-effect models, compared to the lowest CR, the highest was related to a slower decline in global cognition (β = 0.028, 95% confidence interval [CI] 0.012-0.043), episodic memory (β = 0.028, 95% CI 0.010-0.047), and working memory (β = 0.019, 95% CI 0.005-0.033) during the follow-up. In brain pathologic data analysis, the association of the highest CR with cognitive function changes remained significant among participants with high Alzheimer disease pathology or gross infarcts.
Discussion:
High CR indicator is associated with preserved global cognitive function, episodic memory, and working memory, even in the presence of brain pathologies. Our findings highlight the important role of high CR accumulation in the prevention of cognitive decline.
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