Del Ser Teodoro, Valeriano-Lorenzo Elizabeth, Jáñez-Escalada Luis, Ávila-Villanueva Marina, Frades Belén, Zea María-Ascensión, Valentí Meritxell, Zhang Linda, Fernández-Blázquez Miguel A
Clinical Department, Alzheimer's Center Reina Sofia-CIEN Foundation, Madrid, Spain.
Institute of Knowledge Technology, Complutense University, Madrid, Spain.
Front Dement. 2023 Aug 31;2:1099059. doi: 10.3389/frdem.2023.1099059. eCollection 2023.
The relative importance of different components of cognitive reserve (CR), as well as their differences by gender, are poorly established.
To explore several dimensions of CR, their differences by gender, and their effects on cognitive performance and trajectory in a cohort of older people without relevant psychiatric, neurologic, or systemic conditions.
Twenty-one variables related to the education, occupation, social activities, and life habits of 1,093 home-dwelling and cognitively healthy individuals, between 68 and 86 years old, were explored using factorial analyses to delineate several dimensions of CR. These dimensions were contrasted with baseline cognitive performance, follow-up over 5 years of participants' cognitive trajectory, conversion to mild cognitive impairment (MCI), and brain volumes using regression and growth curve models, controlling for gender, age, marital status, number of medications, trait anxiety, depression, and ApoE genotype.
Five highly intercorrelated dimensions of CR were identified, with some differences in their structure and effects based on gender. Three of them, education/occupation, midlife cognitive activities, and leisure activities, were significantly associated with late-life cognitive performance, accounting for more than 20% of its variance. The education/occupation had positive effect on the rate of cognitive decline during the 5-year follow up in individuals with final diagnosis of MCI but showed a reduced risk for MCI in men. None of these dimensions showed significant relationships with gray or white matter volumes.
Proxy markers of CR can be represented by five interrelated dimensions. Education/occupation, midlife cognitive activities, and leisure activities are associated with better cognitive performance in old age and provide a buffer against cognitive impairment. Education/occupation may delay the clinical onset of MCI and is also associated with the rate of change in cognitive performance.
认知储备（CR）不同组成部分的相对重要性及其性别差异尚未明确。
在一组无相关精神、神经或全身性疾病的老年人中，探讨CR的几个维度、其性别差异及其对认知表现和轨迹的影响。
对1093名年龄在68至86岁之间居家且认知健康的个体的教育、职业、社交活动和生活习惯相关的21个变量进行因子分析，以描绘CR的几个维度。使用回归和生长曲线模型，将这些维度与基线认知表现、参与者5年认知轨迹的随访、向轻度认知障碍（MCI）的转化以及脑容量进行对比，同时控制性别、年龄、婚姻状况、用药数量、特质焦虑、抑郁和载脂蛋白E基因型。
确定了CR的五个高度相互关联的维度，其结构和影响存在一些性别差异。其中三个维度，即教育/职业、中年认知活动和休闲活动，与晚年认知表现显著相关，占其方差的20%以上。教育/职业对最终诊断为MCI的个体在5年随访期间的认知衰退率有积极影响，但在男性中显示出较低的MCI风险。这些维度均未显示与灰质或白质体积有显著关系。
CR的替代指标可由五个相互关联的维度表示。教育/职业、中年认知活动和休闲活动与老年时更好的认知表现相关，并为认知障碍提供缓冲。教育/职业可能会延迟MCI的临床发病，也与认知表现的变化率相关。
