Cognitive function in the community setting: the neighbourhood as a source of ‘cognitive reserve’?
Philippa ClarkeJennifer AilshireJames S. HouseJeffrey D. MorenoffKatherine E. KingRobert MelendezKenneth M. Langa
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Abstract:
Background
Existing research has found a positive association between cognitive function and residence in a socioeconomically advantaged neighbourhood. Yet, the mechanisms underlying this relationship have not been empirically investigated.Objective
To test the hypothesis that neighbourhood socioeconomic structure is related to cognitive function partly through the availability of neighbourhood physical and social resources (eg, recreational facilities, community centres and libraries), which promote cognitively beneficial activities such as exercise and social integration.Methods
Using data from a representative survey of community-dwelling adults in the city of Chicago (N=949 adults aged 50 and over), cognitive function was assessed with a modified version of the Telephone Interview for Cognitive Status instrument. Neighbourhood socioeconomic structure was derived from US census indicators. Systematic social observation was used to directly document the presence of neighbourhood resources on the blocks surrounding each respondent9s residence.Results
Using multilevel linear regression, residence in an affluent neighbourhood had a net positive effect on cognitive function after adjusting for individual risk factors. For white respondents, the effects of neighbourhood affluence operated in part through a greater density of institutional resources (eg, community centres) that promote cognitively beneficial activities such as physical activity. Stable residence in an elderly neighbourhood was associated with higher cognitive function (potentially due to greater opportunities for social interaction with peers), but long term exposure to such neighbourhoods was negatively related to cognition.Conclusions
Neighbourhood resources have the potential to promote 'cognitive reserve' for adults who are ageing in place in an urban setting.Keywords:
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Summary The evidence regarding the association between mood and cognitive function is conflicting, suggesting the involvement of moderating factors. This systematic review aimed to assess whether cognitive reserve moderates the association between mood and cognition in older people. Cognitive reserve was considered in terms of the three key proxy measures – educational level, occupation, and engagement in cognitively stimulating leisure activities – individually and in combination. Sixteen studies representing 37,101 participants were included in the review. Of these, 13 used a measure of education, one used a measure of occupation, two used a measure of participation in cognitively stimulating activities, and one used a combination of these. In general, cognitive reserve moderated the association between mood and cognition, with a larger negative association between mood and cognition in those with low cognitive reserve than in those with high cognitive reserve. Further research utilizing multiple proxy measures of cognitive reserve is required to elucidate the associations.
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To the Editor: I appreciate Zhu and colleagues’ comments on our report that higher levels of cognitive reserve, measured according to participation in cognitive leisure activities, reduced risk and severity of postoperative delirium in older adults undergoing surgery.1, 2 They suggest that muscle function not only could be a target for delirium preventive strategies, but also could serve as a cognitive reserve measure. The concept of cognitive reserve postulates that some individual characteristics help maintains cognitive function in the face of accumulating brain pathology.3 Classical definitions of cognitive reserve incorporate passive and active mechanisms.3 Early work proposed that greater cognitive reserve provides an anatomic buffer (also termed brain reserve) by which greater neuronal or synaptic loss secondary to brain injury or pathology can be sustained before clinical symptoms manifest.3, 4 In active models, cognitive reserve is thought to compensate for brain damage by actively using various mechanisms such as recruiting preexisting cognitive networks, improving efficiency of brain processing, and enlisting compensatory brain networks.3 Activities that enhance muscle function may have modest effects on improving or maintaining cognitive function in aging,5 but this association does not equate to being a good measure of cognitive reserve. Under passive and active cognitive reserve models,3 muscle structure and biology are secondary to the underlying cognitive processes and brain substrates that may more directly contribute to cognitive reserve. Hence, although I agree that leisure activities that increase cognitive reserve should be explored as a delirium-preventive strategy, I do not agree that muscle function is a good proxy for characterizing cognitive reserve.2 Conflict of Interest: JV has received funding support from National Institute on Aging Grants R01 AG039330, R01AG044007, AG044829, and R01AG036921. Author Contributions: Verghese V.: was responsible for study concept and design, analysis and interpretation of data, and preparation of manuscript. Sponsor's Role: NA.
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Abstract Background Cognitive reserve (CR) is a concept proposed to account for discrepancies between the extent of brain pathology and clinical manifestations of that pathology. This study aimed to explore the associations between CR and the effects of cognitive training using fully immersive virtual reality (VR). Methods A total of 44 older adults (22 cognitively normal, 22 with mild cognitive impairment) underwent eight cognitive training sessions using VR for a period of 4 weeks. CR was assessed using the Cognitive Reserve Index questionnaire (CRIq). To evaluate baseline cognitive function and the effects of VR training, the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychological battery was administered to all participants before and after the training. Results Greater improvement in the total CERAD score was seen for cognitively normal participants with higher versus lower scores on the Education subdomain of the CRIq. Among patients with mild cognitive impairment, none of the CRIq subdomain scores (Education, Working Activity, Leisure Time) were related to a change in CERAD total scores. The CRIq total score did not predict the improvement of global cognition in either group. Conclusions This study revealed different impacts of CR on cognitive training according to the participants' cognitive status. It also suggests that employing three proxies of CR rather than using a composite score would provide a more accurate understanding of one's CR.
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This study aimed to explore the moderating effects of the frequently used cognitive reserve (CR) proxies [i.e., education, premorbid intelligence quotient (pIQ), occupational complexity (OC), and lifetime cognitive activity (LCA)] on the relationships between various in vivo Alzheimer's disease (AD) pathologies and cognition. In total, 351 [268 cognitively unimpaired (CU), 83 cognitive impaired (CI)] older adults underwent multi-modal brain imaging to measure AD pathologies and cognitive assessments, and information on CR proxies was obtained. For overall participants, only education moderated the relationship between Aβ deposition and cognition. Education, pIQ, and LCA, but not OC, showed moderating effect on the relationship between AD-signature cerebral hypometabolism and cognition. In contrast, only OC had a moderating effect on the relationship between cortical atrophy of the AD-signature regions and cognition. Such moderation effects of the CR proxies were similarly observed in CI individuals, but most of them were not in CU individuals. The findings suggest that the proposed CR proxies have different moderating effects on the relationships between specific AD pathologies and cognition.
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Evidence suggests that individual variability in lifetime exposures influences how cognitive performance changes with advancing age. Brain maintenance and cognitive reserve are theories meant to account for preserved performance despite advancing age. These theories differ in their causal mechanisms. Brain maintenance predicts more advantageous lifetime exposures will reduce age-related neural differences. Cognitive reserve predicts that lifetime exposures will not directly reduce these differences but minimize their impact on cognitive performance. The present work used moderated-mediation modeling to investigate the contributions of these mechanisms at explaining variability in cognitive performance among a group of 39 healthy younger (mean age (standard deviation) 25.9 (2.92) and 45 healthy older adults (65.2 (2.79)). Cognitive scores were computed using composite measures from three separate domains (speed of processing, fluid reasoning, and memory), while their lifetime exposures were estimated using education and verbal IQ measures. T1-weighted MR images were used to measure cortical thickness and subcortical volumes. Results suggest a stronger role for cognitive reserve mechanisms in explaining age-related cognitive variability: even with age-related reduced gray matter, individuals with greater lifetime exposures could perform better given their quantity of brain measures.
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Neuroprotective factors are essential to successful ageing. As such, digital device use was proposed as an easily accessible and stimulating available cognitive activity to enhance brain function. Nonetheless, there was a lack of studies inspecting the connection between digital device use and cognitive reserve, the risk of cognitive impairment, and cognition. This study aims to investigate the potential mediator and moderator of the association between digital device use, cognitive reserve, the risk of cognitive impairment, and cognition among healthy older adults. A quantitative cross-sectional study was conducted to investigate the relationship between digital device use and cognitive reserve, the risk of cognitive impairment, and cognition. A total of 210 healthy older adults were recruited through purposive sampling. The results obtained from this study revealed that there was a significant difference in cognitive reserve and cognition between healthy older adults who use a digital device for communication purpose only and who use a digital device for multiple purposes. A significant relationship was also found between cognitive reserve, the risk of cognitive impairment, and cognition. Although digital device use was found to be significantly associated with cognitive reserve and cognition, it was not significantly associated with the risk of cognitive impairment. Cognitive reserve partially mediated the relationship between digital device use and cognition, supporting the notion that cognitive reserve acts as an underlying mechanism in the relationship between digital device use and cognition. Hence, digital device use was suggested to be a good daily intervention for healthy older adults to build on their cognitive reserve and potentially protect their cognition from declining. Nevertheless, relying on digital device use alone is not sufficient, and other activities should be explored to enhance cognitive reserve among healthy older adults.
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