Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Solna, Sweden.
Biostatistics Unit, Department of Medical Sciences, University of Trieste, Trieste TS, Italy.
Alzheimers Dement. 2024 Jul;20(7):4737-4746. doi: 10.1002/alz.13910. Epub 2024 May 23.
We investigated the association of cognitive reserve (CR) with transitions across cognitive states and death.
This population-based cohort study included 2631 participants (age ≥60 years) who were dementia-free at baseline and regularly examined up to 15 years. Data were analyzed using the Markov multistate models.
Each 1-point increase in the composite CR score (range: -4.25 to 3.46) was significantly associated with lower risks of transition from normal cognition to cognitive impairment, no dementia (CIND) (multivariable-adjusted hazards ratio = 0.78; 95% confidence interval = 0.72-0.85) and death (0.85; 0.79-0.93), and from CIND to death (0.82; 0.73-0.91), but not from CIND to normal cognition or dementia. A greater composite CR score was associated with a lower risk of transition from CIND to death in people aged 60-72 but not in those aged ≥ 78 years.
CR contributes to cognitive health by delaying cognitive deterioration in the prodromal phase of dementia.
We use Markov multistate model to examine the association between cognitive reserve and transitions across cognitive states and death. A great cognitive reserve contributes to cognitive health by delaying cognitive deterioration in the prodromal phase of dementia. A great cognitive reserve is associated with a lower risk of transition from cognitive impairment, no dementia to death in people at the early stage of old age, but not in those at the late stage of old age.
我们研究了认知储备（CR）与认知状态转变和死亡的关系。
本队列研究纳入了 2631 名基线时无痴呆且定期随访长达 15 年的研究对象（年龄≥60 岁）。使用马尔可夫多状态模型进行数据分析。
复合 CR 评分每增加 1 分（范围：-4.25 至 3.46），与从正常认知到认知障碍但无痴呆（CIND）（多变量校正风险比=0.78；95%置信区间=0.72-0.85）和死亡（0.85；0.79-0.93）的转变风险降低显著相关，与从 CIND 到死亡的转变风险降低也显著相关（0.82；0.73-0.91），但与从 CIND 到正常认知或痴呆的转变风险无关。在年龄为 60-72 岁的人群中，较高的复合 CR 评分与从 CIND 到死亡的转变风险降低相关，但在年龄≥78 岁的人群中则不相关。
CR 通过延缓痴呆前驱期的认知恶化，对认知健康做出贡献。
我们使用马尔可夫多状态模型来研究认知储备与认知状态和死亡之间的关系。较高的认知储备通过延缓痴呆前驱期的认知恶化，对认知健康做出贡献。在老年早期阶段，较高的认知储备与从 CIND 到死亡的转变风险降低相关，但在老年晚期阶段则不相关。
