Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois.
Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois.
JAMA Neurol. 2020 Oct 1;77(10):1217-1224. doi: 10.1001/jamaneurol.2020.1941.
Indicators of early-life cognitive enrichment (ELCE) have been associated with slower cognitive decline and decreased dementia in late life. However, the mechanisms underlying this association have not been elucidated.
To examine the association of ELCE with late-life Alzheimer disease (AD) and other common dementia-related pathological changes.
DESIGN, SETTING, AND PARTICIPANTS: This clinical-pathological community-based cohort study, the Rush Memory and Aging Project, followed up participants before death for a mean (SD) of 7.0 (3.8) years with annual cognitive and clinical assessments. From January 1, 1997, through June 30, 2019, 2044 participants enrolled, of whom 1018 died. Postmortem data were leveraged from 813 participants. Data were analyzed from April 12, 2019, to February 20, 2020.
Four indicators of ELCE (early-life socioeconomic status, availability of cognitive resources at 12 years of age, frequency of participation in cognitively stimulating activities, and early-life foreign language instruction) were obtained by self-report at the study baseline, from which a composite measure of ELCE was derived.
A continuous global AD pathology score derived from counts of diffuse plaques, neuritic plaques, and neurofibrillary tangles.
The 813 participants included in the analysis had a mean (SD) age of 90.1 (6.3) years at the time of death, and 562 (69%) were women. In a linear regression model controlled for age at death, sex, and educational level, a higher level of ELCE was associated with a lower global AD pathology score (estimate, -0.057; standard error, 0.022; P = .01). However, ELCE was not associated with any other dementia-related pathological changes. In addition, a higher level of ELCE was associated with less cognitive decline (mean [SD], -0.13 [0.19] units per year; range, -1.74 to 0.85). An indirect effect through AD pathological changes constituted 20% of the association between ELCE and the rate of late-life cognitive decline, and 80% was a direct association.
These findings suggest that ELCE was associated with better late-life cognitive health, in part through an association with fewer AD pathological changes.
早期认知丰富（ELCE）的指标与晚年认知衰退较慢和痴呆症减少有关。然而，这种关联的机制尚未阐明。
研究 ELCE 与晚年阿尔茨海默病（AD）和其他常见与痴呆相关的病理变化的关系。
设计、地点和参与者：这项基于临床和病理的社区队列研究，即拉什记忆和衰老项目，在平均（标准差）7.0（3.8）年的时间内对参与者进行了随访，每年进行一次认知和临床评估。从 1997 年 1 月 1 日至 2019 年 6 月 30 日，共有 2044 名参与者入组，其中 1018 人死亡。利用 813 名参与者的死后数据。数据分析于 2019 年 4 月 12 日至 2020 年 2 月 20 日进行。
通过在研究基线时的自我报告获得四项 ELCE 指标（早期生活社会经济地位、12 岁时认知资源的可用性、参与认知刺激活动的频率以及早期生活外语教学），并由此得出 ELCE 的综合衡量标准。
从弥漫性斑块、神经原纤维缠结和神经纤维缠结的计数中得出连续的 AD 病理总分。
纳入分析的 813 名参与者在死亡时的平均（标准差）年龄为 90.1（6.3）岁，其中 562 名（69%）为女性。在控制死亡时年龄、性别和教育水平的线性回归模型中，较高的 ELCE 水平与较低的 AD 病理总分相关（估计值，-0.057；标准误差，0.022；P=0.01）。然而，ELCE 与任何其他与痴呆相关的病理变化均无关。此外，ELCE 水平较高与认知衰退速度较慢相关（平均[标准差]，-0.13[0.19]单位/年；范围，-1.74 至 0.85）。通过 AD 病理变化的间接影响占 ELCE 与晚年认知衰退速度之间关联的 20%，80%为直接关联。
这些发现表明，ELCE 与晚年认知健康状况较好有关，部分原因是与 AD 病理变化的关联。
