Valenzuela Michael J, Sachdev Perminder
School of Psychiatry, University of New South Wales, AustraliaThe Black Dog Institute, Prince of Wales Hospital, Sydney, Australia.
Psychol Med. 2006 Aug;36(8):1065-73. doi: 10.1017/S0033291706007744. Epub 2006 May 2.
A previous companion paper to this report (Valenzuela and Sachdev, Psychological Medicine 2006, 36, 441-454) suggests a link between behavioural brain reserve and incident dementia; however, the issues of covariate control and ascertainment bias were not directly addressed. Our aim was to quantitatively review an independent set of longitudinal studies of cognitive change in order to clarify these factors.
Cohort studies of the effects of education, occupation, and mental activities on cognitive decline were of interest. Abstracts were identified in MEDLINE (1966-September 2004), CURRENT CONTENTS (to September 2004), PsychINFO (1984-September 2004), Cochrane Library Databases and reference lists from relevant articles. Eighteen studies met inclusion criteria. Key information was extracted by both reviewers onto a standard template with a high level of agreement. Cognitive decline studies were integrated using a non-parametric method after converting outcome data onto a common effect size metric.
Higher behavioural brain reserve was related to decreased longitudinal cognitive decline after control for covariates in source studies (phi=1.70, p<0.001). This effect was robust to correction for both multiple predictors and multiple outcome measures and was the result of integrating data derived from more than 47000 individuals.
This study affirms that the link between behavioural brain reserve and incident dementia is most likely due to fundamentally different cognitive trajectories rather than confound factors.
本报告之前的一篇配套论文（巴伦苏埃拉和萨赫德夫，《心理医学》，2006年，第36卷，第441 - 454页）表明行为性脑储备与新发痴呆症之间存在联系；然而，协变量控制和确定偏倚的问题并未得到直接解决。我们的目的是对一组关于认知变化的纵向研究进行定量综述，以阐明这些因素。
关注教育、职业和心理活动对认知衰退影响的队列研究。在MEDLINE（1966年 - 2004年9月）、《现刊目次》（截至2004年9月）、PsychINFO（1984年 - 2004年9月）、Cochrane图书馆数据库以及相关文章的参考文献列表中检索摘要。18项研究符合纳入标准。两位评审员将关键信息提取到一个标准模板上，一致性很高。在将结果数据转换为通用效应量指标后，使用非参数方法整合认知衰退研究。
在对原始研究中的协变量进行控制后，较高的行为性脑储备与纵向认知衰退的减少相关（phi = 1.70，p < 0.001）。这种效应在对多个预测因素和多个结果测量进行校正后仍然稳健，并且是整合来自超过47000人的数据的结果。
本研究证实行为性脑储备与新发痴呆症之间的联系很可能是由于根本不同的认知轨迹而非混杂因素。
