Department of Neurology, Shandong Provincial Hospital, Jinan, Shandong, P.R. China.
Aging Research Center and Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
J Alzheimers Dis. 2023;92(1):261-272. doi: 10.3233/JAD-220864.
Cognitive reserve (CR) partly explains cognitive variability in the presence of pathological brain aging.
We investigated the interplay of lifelong CR with age, sex, and brain aging markers in cognitive phenotypes among older adults with very limited education.
This population-based cross-sectional study included 179 dementia-free participants (age ≥65 years; 39.7% women; 67.0% had no or elementary education) examined in 2014-2016. We assessed lacunes and volumes of hippocampus, ventricles, grey matter, white matter (WM), and white matter hyperintensities. Lifelong CR score was generated from six lifespan intellectual factors (e.g., education and social support). We used Mini-Mental State Examination (MMSE) score to assess cognition and Petersen's criteria to define mild cognitive impairment (MCI). Data were analyzed using general linear and logistic models.
The association of higher lifelong CR score (range: -4.0-5.0) with higher MMSE score was stronger in women (multivariable-adjusted β-coefficient and 95% CI: 1.75;0.99-2.51) than in men (0.68;0.33-1.03) (pinteraction = 0.006). The association of higher CR with MCI (multivariable-adjusted odds ratio and 95% CI: 0.77;0.60-0.99) did not vary by age or sex. Among participants with low CR (<1.4[median]), greater hippocampal and WM volumes were related to higher MMSE scores with multivariable-adjusted β-coefficients being 1.77(0.41-3.13) and 0.44(0.15-0.74); the corresponding figures in those with high CR were 0.15(-0.76-1.07) and -0.17(-0.41-0.07) (pinteraction <0.01). There was no statistical interaction of CR with MRI markers on MCI.
Greater lifelong CR capacity is associated with better late-life cognition among people with limited education, possibly by compensating for impact of neurodegeneration.
认知储备（CR）部分解释了病理性脑老化存在时认知的可变性。
我们研究了终生认知储备与年龄、性别以及大脑老化标志物在受教育程度较低的老年人认知表型中的相互作用。
这项基于人群的横断面研究纳入了 179 名无痴呆症的参与者（年龄≥65 岁；39.7%为女性；67.0%受教育程度为无或小学），研究于 2014 年至 2016 年进行。我们评估了腔隙和海马体、脑室、灰质、白质（WM）和 WM 高信号的体积。终生认知储备评分是根据六个终生智力因素（例如，教育和社会支持）得出的。我们使用简易精神状态检查（MMSE）评分评估认知，并用 Petersen 标准定义轻度认知障碍（MCI）。数据采用一般线性和逻辑模型进行分析。
终生认知储备评分较高（范围为-4.0 至 5.0）与女性的 MMSE 评分较高（多变量调整后β系数和 95%置信区间：1.75；0.99-2.51）相关性更强，而与男性（0.68；0.33-1.03）（p 交互=0.006）。较高的 CR 与 MCI（多变量调整后比值比和 95%置信区间：0.77；0.60-0.99）的关联不因年龄或性别而异。在认知储备较低（<1.4[中位数]）的参与者中，更大的海马体和 WM 体积与较高的 MMSE 评分相关，多变量调整后的β系数分别为 1.77（0.41-3.13）和 0.44（0.15-0.74）；而在认知储备较高的参与者中，相应的数值为 0.15（-0.76-1.07）和-0.17（-0.41-0.07）（p 交互<0.01）。CR 与 MRI 标志物在 MCI 上的交互作用无统计学意义。
在受教育程度较低的人群中，更大的终生认知储备能力与更好的晚年认知相关，这可能是通过补偿神经退行性变的影响来实现的。
