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Association between Cognitive Reserve Indicator and Chronic Disease-Free Survival: A Large Community-Based
1Hong Zhu, Associate Professor, Dept. of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Qixiangtai Road 22, Heping District, 300070, Tianjin, P.R. China. Email: zhuhong@tmu.edu.cn; Weili Xu, Professor, Dept. of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Qixiangtai Road 22, Heping District, 300070, Tianjin, P.R. China; Aging Research Center, Karolinska Institutet, Tomtebodavägen 18A Floor 10, SE-171 65 Solna, Stockholm, Sweden. Phone: +46 8 524 858 26;
Insights
High cognitive reserve (CR) is linked to a reduced risk of chronic diseases and death, potentially extending disease-free survival. Promoting CR through lifestyle choices is crucial for health longevity, particularly for younger individuals and smokers.
Area of Science:
- Gerontology and Public Health
- Epidemiology and Biostatistics
Background:
- Cognitive reserve (CR) is associated with dementia and aging outcomes, but its link to other chronic diseases and mortality is not fully understood.
- Understanding CR's role in preventing multiple chronic diseases is essential for promoting healthy aging.
Purpose of the Study:
- To investigate the association between cognitive reserve (CR) and survival free from major chronic diseases.
- To determine if higher CR levels correlate with a reduced risk of developing conditions like dementia, diabetes, cardiovascular diseases, COPD, and cancer.
Main Methods:
- A community-based longitudinal study utilizing UK Biobank data from 412,509 participants.
- Latent class analysis identified CR levels (low, moderate, high) based on education, occupation, and lifestyle factors.
- Follow-up assessed chronic disease incidence and survival status, with analyses exploring interactions with sex, age, and lifestyle.
Main Results:
- High CR was associated with a significantly lower risk of developing chronic diseases or death (HR 0.82).
- Participants with high CR experienced prolonged chronic disease-free survival by 1.33 years compared to those with low CR.
- The protective association of CR was stronger in individuals under 60 and current smokers.
Conclusions:
- A high cognitive reserve indicator is linked to reduced risk of chronic disease and mortality, potentially extending disease-free survival.
- CR-enhancing lifestyle factors and experiences are vital for promoting health longevity.
- Targeted interventions focusing on CR may be particularly beneficial for younger populations and smokers.
Background:
Cognitive reserve (CR) has been linked to dementia and might be a predictor of aged-related outcomes. However, the association between CR and risk of other chronic diseases and mortality remains unclear.
Objectives:
We aimed to investigate the association of CR with survival free from major chronic diseases.
Design, Setting And Participants:
This community-based longitudinal study used data from the UK Biobank. A total of 412,509 participants (mean age 55.71±8.10) free of major chronic disease (including dementia, diabetes, cardiovascular diseases, chronic obstructive pulmonary disease, and cancer) completed the baseline examination between 2006 to 2010 and were followed for changes in health status.
Measurements:
Latent class analysis was used to generate an indicator of CR (categorized as low, moderate, or high) based on education, occupation, television viewing time, confiding, social connection, and leisure activities. Major chronic diseases and survival status were ascertained through self-reported history and/or linkages to medical and death records. Chronic disease-free survival was defined as survival without any of the aforementioned chronic diseases. Effect modifications and interactions between the CR indicator and sex, age, and lifestyle factors (including smoking status, alcohol consumption, physical activity, and body mass index) were explored.
Results:
Over a median follow-up of 12.49 (interquartile range 11.42-13.41, range 0.01-15.87) years, 112,190 (27.2%) participants died or developed at least one chronic disease. High CR indicator was associated with lower risk of chronic disease/death (hazard ratio 0.82, 95% confidence interval: 0.80-0.83) compared to low CR indicator. Chronic disease-free survival was prolonged by 1.33 (1.21-1.44) years among participants with high CR compared to low CR indicator. Furthermore, the association between the CR indicator and chronic disease-free survival was strengthened among individuals aged <60 years and current smokers.
Conclusion:
High CR indicator is associated with a lower risk of chronic disease/death and may prolong chronic disease-free survival. Our findings underscore the importance of CR-enhancing lifestyle and experiences in health longevity, especially for younger individuals and current smokers.
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