Veronelli Laura, Tosi Giorgia, Romano Daniele
Department of Psychology, University of Milano-Bicocca and Milan Center for Neuroscience, Milan, Italy; Department of Neurorehabilitation Sciences, Casa di Cura IGEA, Milan, Italy.
Department of Psychology, University of Milano-Bicocca and Milan Center for Neuroscience, Milan, Italy.
Neurobiol Aging. 2025 Mar;147:60-67. doi: 10.1016/j.neurobiolaging.2024.12.002. Epub 2024 Dec 13.
Cognitive Reserve (CR) refers to the brain's ability, supported by active and modifiable forms of lifestyle compensation, to cope with neural changes due to age or disease, delaying the onset of cognitive deficits. In CR studies, neuropsychological performances and functional autonomy are considered alternative outcomes. While decreased functional independence gains importance in dementia diagnosis and monitoring, cognitive functioning may play a role in staging its severity. The main aim of the present study was to test a longitudinal model of Alzheimer's Disease (AD), in which CR (years of education) and current cognitive status (Mini-Mental State Examination, MMSE, score) would predict clinical progression in terms of loss of functional independence at a later time. From the ADNI database, we considered 308 AD participants, and for 180 of them, we could extract CSF Aβ1-42 baseline levels as an index of amyloid burden. Functional decline (one-year delta score at the Functional Activities of Daily Living Questionnaire) was explained by the CR and MMSE score interaction net of age; a trend was found also when controlling for amyloid burden. Functional decline at one year was increased for patients with high CR levels and low MMSE and with low CR and high cognitive state, compared to the opposite. The present investigation demonstrated the mutual role of past acquired CR and current cognitive status in predicting functional progression in AD. The study suggests a way to predictively interpret available demographic and clinical data, defining differential longitudinal trajectories that might be useful for clinical management.
认知储备（CR）是指大脑在积极且可改变的生活方式补偿的支持下，应对因年龄或疾病导致的神经变化，延缓认知缺陷发作的能力。在认知储备研究中，神经心理表现和功能自主性被视为替代结果。虽然功能独立性下降在痴呆症诊断和监测中变得越来越重要，但认知功能可能在其严重程度分期中发挥作用。本研究的主要目的是测试阿尔茨海默病（AD）的纵向模型，其中认知储备（受教育年限）和当前认知状态（简易精神状态检查表，MMSE，得分）将预测后期功能独立性丧失方面的临床进展。从ADNI数据库中，我们纳入了308名AD参与者，其中180名参与者，我们可以提取脑脊液Aβ1 - 42基线水平作为淀粉样蛋白负荷的指标。功能衰退（日常生活功能问卷的一年变化得分）由认知储备和MMSE得分在年龄校正后的交互作用来解释；在控制淀粉样蛋白负荷时也发现了一种趋势。与相反情况相比，认知储备水平高且MMSE得分低以及认知储备低且认知状态高的患者，一年时的功能衰退增加。本研究表明了过去获得的认知储备和当前认知状态在预测AD功能进展中的相互作用。该研究提出了一种预测性解释现有人口统计学和临床数据的方法，定义了可能对临床管理有用的不同纵向轨迹。
