Center for Cognitive Neurology, Department of Neurology, New York University Grossman School of Medicine, New York.
The Framingham Study, Boston, Massachusetts.
JAMA Netw Open. 2021 Aug 2;4(8):e2121122. doi: 10.1001/jamanetworkopen.2021.21122.
Cognitive resilience refers to the general capacity of cognitive processes to be less susceptible to differences in brain structure from age- and disease-related changes. Studies suggest that supportive social networks reduce Alzheimer disease and related disorder (ADRD) risk by enhancing cognitive resilience, but data on specific social support mechanisms are sparse.
To examine the association of individual forms of social support with a global neuroanatomical measure of early ADRD vulnerability and cognition.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional analysis used prospectively collected data from Framingham Study participants without dementia, stroke, or other neurological conditions who underwent brain magnetic resonance imaging and neuropsychological testing at the same visit. Data from this large, population-based, longitudinal cohort were collected from June 6, 1997, to December 13, 1999 (original cohort), and from September 11, 1998, to October 26, 2001 (offspring cohort). Data were analyzed from May 22, 2017, to June 1, 2021.
Total cerebral volume and, as a modifying exposure variable, self-reported availability of 5 types of social support measured by the Berkman-Syme Social Network Index.
The primary outcome was a global measure of cognitive function. Cognitive resilience was defined as the modification of total cerebral volume's association with cognition, such that smaller β estimates (presented in SD units) indicate greater cognitive resilience (ie, better cognitive performance than estimated by lower total cerebral volume).
The study included 2171 adults (164 in the original cohort and 2007 in the offspring cohort; mean [SD] age, 63 [10] years; 1183 [54%] female). High listener availability was associated with greater cognitive resilience (β = 0.08, P < .001) compared with low listener availability (β = 0.20, P = .002). Overall findings persisted after adjustment for potential confounders. Other forms of social support were not significant modifiers (advice: β = -0.04; P = .40 for interaction; love-affection: β = -0.07, P = .28 for interaction; emotional support: β = -0.02, P = .73 for interaction; and sufficient contact: β = -0.08; P = .11 for interaction).
The results of this cross-sectional cohort study suggest that social support in the form of supportive listening is associated with greater cognitive resilience, independently modifying the association between lower total cerebral volume and poorer cognitive function that would otherwise indicate increased ADRD vulnerability at the preclinical stage. A refined understanding of social support mechanisms has the potential to inform strategies to reduce ADRD risk and enhance cognitive resilience.
认知弹性是指认知过程的一般能力，使其不易受到与年龄和疾病相关的大脑结构变化的影响。研究表明，支持性社交网络通过增强认知弹性降低阿尔茨海默病和相关疾病（ADRD）的风险，但关于特定社交支持机制的数据很少。
研究个体形式的社会支持与早期 ADRD 脆弱性和认知的全球神经解剖学测量之间的关联。
设计、地点和参与者：这是一项回顾性的横断面分析，使用弗雷明汉研究参与者在没有痴呆、中风或其他神经疾病的情况下前瞻性收集的数据，这些参与者在同一就诊时接受了脑磁共振成像和神经心理学测试。这项大型、基于人群的纵向队列的数据于 1997 年 6 月 6 日至 1999 年 12 月 13 日（原始队列）和 1998 年 9 月 11 日至 2001 年 10 月 26 日（后代队列）收集。数据于 2017 年 5 月 22 日至 2021 年 6 月 1 日进行分析。
总脑容量，以及作为修饰暴露变量的自我报告的 5 种社会支持类型的可用性，通过 Berkman-Syme 社会网络指数测量。
主要结果是认知功能的全球衡量标准。认知弹性被定义为总脑容量与认知之间关联的修饰，较小的β估计值（以标准差单位表示）表示更大的认知弹性（即，比总脑容量估计的更好的认知表现）。
该研究包括 2171 名成年人（原始队列 164 名，后代队列 2007 名；平均[标准差]年龄 63[10]岁；1183[54%]为女性）。高倾听者可用性与更大的认知弹性相关（β=0.08，P<0.001），而低倾听者可用性则不相关（β=0.20，P=0.002）。在调整潜在混杂因素后，总体结果仍然存在。其他形式的社会支持不是重要的修饰剂（建议：β=-0.04；P=0.40 用于交互；爱与感情：β=-0.07，P=0.28 用于交互；情感支持：β=-0.02，P=0.73 用于交互；充足的联系：β=-0.08；P=0.11 用于交互）。
这项横断面队列研究的结果表明，支持性倾听形式的社会支持与更大的认知弹性相关，独立修饰总脑容量较低与认知功能较差之间的关联，否则会表明在临床前阶段增加 ADRD 脆弱性。对社会支持机制的更深入理解有可能为降低 ADRD 风险和增强认知弹性提供信息。
