Linking Cognitive and Behavioral Reserve: Evidence from the CAN-PROTECT Study

Overview

Journal Alzheimers Dement (N Y)

Date 2024 Oct 7

PMID 39372373

Authors

Dylan X Guan

Moyra E Mortby

G Bruce Pike

Clive Ballard

Byron Creese

Anne Corbett

Ellie Pickering

Adam Hampshire

Pamela Roach

Eric E Smith

Zahinoor Ismail

Affiliations

Soon will be listed here.

Abstract

Introduction: Changes to the brain due to Alzheimer's disease and other age-related neuropathologies may present with cognitive and behavioral symptoms, even during preclinical and prodromal stages. While cognitive reserve is known to mitigate cognitive decline in the preclinical stages of Alzheimer's disease, links between cognitive reserve and behavioral symptoms remain unclear. This study investigates the relationship between cognitive reserve and mild behavioral impairment (MBI), a neurodegenerative behavioral prodrome.

Methods: We analyzed cross-sectional data from 1204 participants in the Canadian Platform for Research Online to Investigate Health, Quality of Life, Cognition, Behavior, Function, and Caregiving in Aging (CAN-PROTECT) study. A cognitive reserve score (CRS) was generated based on education, occupation, and personal cognitive reserve proxies. MBI presence (MBI+) and MBI global and domain symptom severity were evaluated using the self-reported MBI Checklist. Initial analyses examined the convergent validity of the CRS through associations with objective neuropsychological test performance and self-reported cognitive symptoms (Everyday Cognition [ECog-II] scale). Models were also fitted to assess MBI status and severity as functions of the CRS.

Results: Higher CRS was associated with better neuropsychological test scores, lower odds of subjective cognitive decline (OR = 0.86, 95% CI: [0.76, 0.98], = .03), and lower ECog-II total score. Likewise, higher CRS was associated with lower odds of MBI+ (OR = 0.81, 95% CI: [0.71, 0.93], = .003), and lower MBI symptom severity globally, and in impulse dyscontrol and social inappropriateness domains.

Discussion: We provide preliminary evidence that engagement in activities known to preserve cognitive function in aging and disease may also preserve behavioral function. Future research should disentangle possible pathways through which cognitive reserve may preserve both cognition and behavior, explore common etiologies for these symptoms, and observe outcomes longitudinally to better understand these relationships.

Highlights: Education, occupation, and personal activities are cognitive reserve proxies.Cognitive reserve is linked to lower subjective cognitive decline in older persons.Cognitive reserve is linked to lower mild behavioral impairment odds and severity.

Citing Articles

Linking cognitive and behavioral reserve: Evidence from the CAN-PROTECT study.

Guan D, Mortby M, Pike G, Ballard C, Creese B, Corbett A Alzheimers Dement (N Y). 2024; 10(4):e12497.

PMID: 39372373 PMC: 11450604. DOI: 10.1002/trc2.12497.

References

Clare L, Wu Y, Teale J, MacLeod C, Matthews F, Brayne C . Potentially modifiable lifestyle factors, cognitive reserve, and cognitive function in later life: A cross-sectional study. PLoS Med. 2017; 14(3):e1002259. PMC: 5360216. DOI: 10.1371/journal.pmed.1002259. View

Song S, Stern Y, Gu Y . Modifiable lifestyle factors and cognitive reserve: A systematic review of current evidence. Ageing Res Rev. 2021; 74:101551. PMC: 8794051. DOI: 10.1016/j.arr.2021.101551. View

Inamura K, Shinagawa S, Nagata T, Tagai K, Nukariya K, Shigeta M . Education level is associated with neuropsychiatric symptoms in patients with amnestic-mild cognitive impairment. Psychogeriatrics. 2022; 22(3):343-352. DOI: 10.1111/psyg.12818. View

Franzmeier N, Gottler J, Grimmer T, Drzezga A, Araque-Caballero M, Simon-Vermot L . Resting-State Connectivity of the Left Frontal Cortex to the Default Mode and Dorsal Attention Network Supports Reserve in Mild Cognitive Impairment. Front Aging Neurosci. 2017; 9:264. PMC: 5545597. DOI: 10.3389/fnagi.2017.00264. View

Guan D, Rockwood K, Smith E, Ismail Z . Sex Moderates the Association between Frailty and Mild Behavioral Impairment. J Prev Alzheimers Dis. 2022; 9(4):692-700. DOI: 10.14283/jpad.2022.61. View

Stern Y, Arenaza-Urquijo E, Bartres-Faz D, Belleville S, Cantilon M, Chetelat G . Whitepaper: Defining and investigating cognitive reserve, brain reserve, and brain maintenance. Alzheimers Dement. 2018; 16(9):1305-1311. PMC: 6417987. DOI: 10.1016/j.jalz.2018.07.219. View

Scarpina F, Tagini S . The Stroop Color and Word Test. Front Psychol. 2017; 8:557. PMC: 5388755. DOI: 10.3389/fpsyg.2017.00557. View

Stern Y . Cognitive reserve in ageing and Alzheimer's disease. Lancet Neurol. 2012; 11(11):1006-12. PMC: 3507991. DOI: 10.1016/S1474-4422(12)70191-6. View

Wolfova K, Creese B, Aarsland D, Ismail Z, Corbett A, Ballard C . Gender/Sex Differences in the Association of Mild Behavioral Impairment with Cognitive Aging. J Alzheimers Dis. 2022; 88(1):345-355. DOI: 10.3233/JAD-220040. View

10.

Soldan A, Pettigrew C, Albert M . Cognitive Reserve from the Perspective of Preclinical Alzheimer Disease: 2020 Update. Clin Geriatr Med. 2020; 36(2):247-263. PMC: 7837205. DOI: 10.1016/j.cger.2019.11.006. View

11.

Owen A, Downes J, Sahakian B, Polkey C, Robbins T . Planning and spatial working memory following frontal lobe lesions in man. Neuropsychologia. 1990; 28(10):1021-34. DOI: 10.1016/0028-3932(90)90137-d. View

12.

Kan C, Cano J, Zhao X, Ismail Z, Chen C, Xu X . Prevalence, Clinical Correlates, Cognitive Trajectories, and Dementia Risk Associated With Mild Behavioral Impairment in Asians. J Clin Psychiatry. 2022; 83(3). DOI: 10.4088/JCP.21m14105. View

13.

Smallwood J, Bernhardt B, Leech R, Bzdok D, Jefferies E, Margulies D . The default mode network in cognition: a topographical perspective. Nat Rev Neurosci. 2021; 22(8):503-513. DOI: 10.1038/s41583-021-00474-4. View

14.

Clancy U, Gilmartin D, Jochems A, Knox L, Doubal F, Wardlaw J . Neuropsychiatric symptoms associated with cerebral small vessel disease: a systematic review and meta-analysis. Lancet Psychiatry. 2021; 8(3):225-236. DOI: 10.1016/S2215-0366(20)30431-4. View

15.

Huntley J, Corbett A, Wesnes K, Brooker H, Stenton R, Hampshire A . Online assessment of risk factors for dementia and cognitive function in healthy adults. Int J Geriatr Psychiatry. 2017; 33(2):e286-e293. DOI: 10.1002/gps.4790. View

16.

Guan D, Mortby M, Pike G, Ballard C, Creese B, Corbett A . Linking cognitive and behavioral reserve: Evidence from the CAN-PROTECT study. Alzheimers Dement (N Y). 2024; 10(4):e12497. PMC: 11450604. DOI: 10.1002/trc2.12497. View

17.

Ismail Z, Leon R, Creese B, Ballard C, Robert P, Smith E . Optimizing detection of Alzheimer's disease in mild cognitive impairment: a 4-year biomarker study of mild behavioral impairment in ADNI and MEMENTO. Mol Neurodegener. 2023; 18(1):50. PMC: 10386685. DOI: 10.1186/s13024-023-00631-6. View

18.

Apostolova L, Di L, Duffy E, Brook J, Elashoff D, Tseng C . Risk factors for behavioral abnormalities in mild cognitive impairment and mild Alzheimer's disease. Dement Geriatr Cogn Disord. 2014; 37(5-6):315-26. PMC: 4057985. DOI: 10.1159/000351009. View

19.

Karp A, Andel R, Parker M, Wang H, Winblad B, Fratiglioni L . Mentally stimulating activities at work during midlife and dementia risk after age 75: follow-up study from the Kungsholmen Project. Am J Geriatr Psychiatry. 2009; 17(3):227-36. DOI: 10.1097/JGP.0b013e318190b691. View

20.

Matuskova V, Ismail Z, Nikolai T, Markova H, Cechova K, Nedelska Z . Mild Behavioral Impairment Is Associated With Atrophy of Entorhinal Cortex and Hippocampus in a Memory Clinic Cohort. Front Aging Neurosci. 2021; 13:643271. PMC: 8180573. DOI: 10.3389/fnagi.2021.643271. View