From the Department of Epidemiology and Biostatistics (X.L., R.S., X.Q., W.Y., W.X.), School of Public Health, Tianjin Medical University; Tianjin Key Laboratory of Environment, Nutrition and Public Health (X.L., R.S., X.Q., W.Y., W.X.); Center for International Collaborative Research on Environment, Nutrition and Public Health (X.L., R.S., X.Q., W.Y., W.X.), Tianjin; Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine (R.S.), Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan; Big Data and Engineering Research Center (H.X.), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China; Division of Clinical Geriatrics, Center for Alzheimer Research (M.K.), and Aging Research Center (W.X.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet; Theme Aging (M.K.), Karolinska University Hospital, Stockholm, Sweden; Ageing and Epidemiology (AGE) Research Unit (M.K.), School of Public Health, Imperial College London, UK; and Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL.
Neurology. 2021 Oct 26;97(17):e1695-e1706. doi: 10.1212/WNL.0000000000012728. Epub 2021 Sep 7.
Evidence on the association of cognitive reserve (CR) with the cognitive trajectories is limited. We aimed to examine the influence of CR indicator on domain-specific cognitive trajectories taking brain pathologies into account.
Within the Rush Memory and Aging Project, 1,697 participants without dementia (mean age 79.6 years) were followed up to 21 years. CR indicator encompassing education, early-life, mid-life, and late-life cognitive activities and late-life social activity was ascertained at baseline and categorized as tertiles (lowest, middle, and highest). Global cognition, episodic memory, semantic memory, working memory, visuospatial ability, and perceptual speed were assessed annually with 19 tests, from which composite scores were derived. During the follow-up, 648 participants died and underwent autopsies to evaluate brain pathologies. Data were analyzed using linear mixed-effect models.
Among the participants, the score of the CR indicator ranged from -8.00 to 5.74 (mean 0.00 ± 2.23). In multi-adjusted mixed-effect models, compared to the lowest CR, the highest was related to a slower decline in global cognition (β = 0.028, 95% confidence interval [CI] 0.012-0.043), episodic memory (β = 0.028, 95% CI 0.010-0.047), and working memory (β = 0.019, 95% CI 0.005-0.033) during the follow-up. In brain pathologic data analysis, the association of the highest CR with cognitive function changes remained significant among participants with high Alzheimer disease pathology or gross infarcts.
High CR indicator is associated with preserved global cognitive function, episodic memory, and working memory, even in the presence of brain pathologies. Our findings highlight the important role of high CR accumulation in the prevention of cognitive decline.
认知储备（CR）与认知轨迹之间关联的证据有限。我们旨在研究考虑到脑病理的情况下，CR 指标对特定领域认知轨迹的影响。
在 Rush 记忆与衰老项目中，对 1697 名无痴呆症的参与者（平均年龄 79.6 岁）进行了长达 21 年的随访。CR 指标涵盖了教育、早年、中年和晚年的认知活动以及晚年的社会活动，在基线时确定，并分为三分位数（最低、中、最高）。每年使用 19 项测试评估总体认知、情景记忆、语义记忆、工作记忆、视空间能力和知觉速度，从这些测试中得出综合分数。在随访期间，648 名参与者死亡并接受了尸检以评估脑病理。使用线性混合效应模型分析数据。
在参与者中，CR 指标的分数范围为-8.00 至 5.74（平均值 0.00 ± 2.23）。在多调整的混合效应模型中，与最低 CR 相比，最高 CR 与全球认知（β=0.028，95%置信区间[CI]0.012-0.043）、情景记忆（β=0.028，95%CI0.010-0.047）和工作记忆（β=0.019，95%CI0.005-0.033）的下降速度较慢有关。在脑病理数据分析中，在高阿尔茨海默病病理或大面积梗死的参与者中，最高 CR 与认知功能变化的关联仍然显著。
高 CR 指标与整体认知功能、情景记忆和工作记忆的保留有关，即使存在脑病理。我们的研究结果强调了高 CR 积累在预防认知能力下降方面的重要作用。
