Khalaila Rabia, Dintica Christina, Yaffe Kristine
Department of Neurology, Global Brain Health Institute, University of California San Francisco, San Francisco, California, USA.
Nursing Department, Zefat Academic College, Zefat, Israel.
Innov Aging. 2024 Feb 14;8(2):igae014. doi: 10.1093/geroni/igae014. eCollection 2024.
Prior studies on cognitive reserve (CR) and cognitive trajectories are limited and have had conflicting results. Furthermore, most studies have used a single measure of CR that may not reflect a comprehensive exposure. The objective of this study is to determine the impact of individual and composite CR measures on cognitive decline over a 6-year period.
We studied 55,340 participants from 16 European countries, aged 50 and older, who participated in the Survey of Health, Aging, and Retirement in Europe. We used cognitive measures (including immediate memory, delayed memory, verbal fluency, and numeracy) and 3 CR factors (education, occupation, and cognitive activities) collected in 4 waves from 2011 to 2017. Structural equation modeling was used to construct the composite CR score, analyzed as tertile. Linear mixed-effect models were used to examine the study aims.
At baseline, the highest composite CR tertile was associated with a higher cognition score than the middle and lowest CR tertiles (β: -0.28, 95% confidence interval [CI]: -0.29 to -0.26; β: -0.71, 95% CI: -0.72 to -0.70, respectively), as well as for all individual cognitive domains. At longitudinal results, compared with the lowest CR, the highest but not the middle CR tertile demonstrated a slower 6-year decline in global cognition (β: -0.02, 95 % CI: -0.03 to -0.01), as well as in all cognitive domains ( < .05).
A composite CR could be a protective factor for cognitive performance and cognitive decline, and it is more sensitive and inclusive than an individual CR indicator alone.
先前关于认知储备（CR）和认知轨迹的研究有限，且结果相互矛盾。此外，大多数研究仅采用单一的认知储备测量方法，可能无法全面反映暴露情况。本研究的目的是确定个体和综合认知储备测量方法对6年期间认知衰退的影响。
我们研究了来自16个欧洲国家的55340名50岁及以上的参与者，他们参与了欧洲健康、老龄化和退休调查。我们使用了2011年至2017年4次调查中收集的认知测量指标（包括即时记忆、延迟记忆、语言流畅性和计算能力）以及3个认知储备因素（教育、职业和认知活动）。采用结构方程模型构建综合认知储备得分，并分析为三分位数。使用线性混合效应模型来检验研究目的。
在基线时，与中等和低认知储备三分位数相比，高综合认知储备三分位数与更高的认知得分相关（β：-0.28，95%置信区间[CI]：-0.29至-0.26；β：-0.71，95%CI：-0.72至-0.70），所有个体认知领域均如此。在纵向结果中，与低认知储备相比，高认知储备三分位数（而非中等认知储备三分位数）在全球认知方面显示出较慢的6年衰退（β：-0.02，95%CI：-0.03至-0.01），所有认知领域均如此（P<0.05）。
综合认知储备可能是认知表现和认知衰退的保护因素，并且比单独的个体认知储备指标更敏感、更具包容性。
