School of Aging Studies, University of South Florida, Tampa, FL, USA.
Department of Neurology, University of Southern California, Los Angeles, CA, USA.
Neuropsychol Rev. 2021 Jun;31(2):233-250. doi: 10.1007/s11065-021-09478-4. Epub 2021 Jan 8.
Cognitive reserve (CR) may reduce the risk of dementia. We summarized the effect of CR on progression to mild cognitive impairment (MCI) or dementia in studies accounting for Alzheimer's disease (AD)-related structural pathology and biomarkers. Literature search was conducted in Web of Science, PubMed, Embase, and PsycINFO. Relevant articles were longitudinal, in English, and investigating MCI or dementia incidence. Meta-analysis was conducted on nine articles, four measuring CR as cognitive residual of neuropathology and five as composite psychosocial proxies (e.g., education). High CR was related to a 47% reduced relative risk of MCI or dementia (pooled-hazard ratio: 0.53 [0.35, 0.81]), with residual-based CR reducing risk by 62% and proxy-based CR by 48%. CR protects against MCI and dementia progression above and beyond the effect of AD-related structural pathology and biomarkers. The finding that proxy-based measures of CR rivaled residual-based measures in terms of effect on dementia incidence underscores the importance of early- and mid-life factors in preventing dementia later.
认知储备（CR）可能降低痴呆的风险。我们总结了考虑到与阿尔茨海默病（AD）相关的结构病理学和生物标志物的研究中 CR 对进展为轻度认知障碍（MCI）或痴呆的影响。在 Web of Science、PubMed、Embase 和 PsycINFO 中进行了文献检索。相关文章为纵向研究，使用英语，并且调查了 MCI 或痴呆的发病率。对九篇文章进行了荟萃分析，其中四篇将 CR 作为神经病理学的认知残留来衡量，五篇将 CR 作为综合心理社会指标（如教育）来衡量。高 CR 与 MCI 或痴呆的相对风险降低 47%（合并风险比：0.53[0.35，0.81]）相关，基于残留的 CR 降低了 62%的风险，基于代理的 CR 降低了 48%的风险。CR 除了 AD 相关的结构病理学和生物标志物的影响之外，还能预防 MCI 和痴呆的进展。基于代理的 CR 在痴呆发病率方面的效果与基于残留的 CR 相当，这凸显了在生命早期和中期采取措施预防晚年痴呆的重要性。
