Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA,
Acta Neuropathol. 2014 Jan;127(1):137-50. doi: 10.1007/s00401-013-1226-2. Epub 2013 Dec 20.
Many studies report an association of cognitive and social experiential factors and related traits with dementia risk. Further, many clinical-pathologic studies find a poor correspondence between levels of neuropathology and the presence of dementia and level of cognitive impairment. The poor correspondence suggests that other factors contribute to the maintenance or loss of cognitive function, with factors associated with the maintenance of function referred to as neural or cognitive reserve. This has led investigators to examine the associations of cognitive and social experiential factors with neuropathology as a first step in disentangling the complex associations between these experiential risk factors, neuropathology, and cognitive impairment. Despite the consistent associations of a range of cognitive and social lifestyle factors with cognitive decline and dementia risk, the extant clinical-pathologic data find only a single factor from one cohort, linguistic ability, related to AD pathology. Other factors, including education, harm avoidance, and emotional neglect, are associated with cerebrovascular disease. Overall, the associations are weak. Some factors, such as education, social networks, and purpose in life, modify the relation of neuropathology to cognition. Finally, some factors such as cognitive activity appear to bypass known pathologies altogether suggesting a more direct association with biologic indices that promote person-specific differences in reserve and resilience. Future work will first need to replicate findings across more studies to ensure the veracity of the existing data. Second, effort is needed to identify the molecular substrates of neural reserve as potential mediators of the association of lifestyle factors with cognition.
许多研究报告表明认知和社会经验因素及相关特征与痴呆风险之间存在关联。此外，许多临床病理研究发现，神经病理学的水平与痴呆的存在和认知障碍的水平之间存在较差的对应关系。这种较差的对应关系表明，其他因素也有助于维持或丧失认知功能，与维持功能相关的因素被称为神经或认知储备。这促使研究人员检查认知和社会经验因素与神经病理学之间的关联，作为厘清这些经验风险因素、神经病理学和认知障碍之间复杂关联的第一步。尽管一系列认知和社会生活方式因素与认知衰退和痴呆风险之间存在一致的关联，但现有的临床病理数据仅在一个队列中发现了一个与 AD 病理相关的单一因素，即语言能力。其他因素，包括教育、回避伤害和情感忽视，与脑血管疾病有关。总的来说，这些关联是微弱的。一些因素，如教育、社交网络和生活目标，会改变神经病理学与认知之间的关系。最后，一些因素，如认知活动，似乎完全绕过了已知的病理，这表明与促进个体差异的储备和韧性的生物学指标有更直接的关联。未来的工作首先需要在更多的研究中复制这些发现，以确保现有数据的真实性。其次，需要努力确定神经储备的分子基础，作为生活方式因素与认知相关的潜在中介。
