Abstract

OBJECTIVE: To examine cross-sectional effects of cognitive reserve (CR) and brain reserve (BR) on cognition across the spectrum of Alzheimer disease (AD).

METHODS: We included 663 AD biomarker-positive participants with dementia (probable AD, n = 462) or in the predementia stages (preclinical/prodromal AD, n = 201). Education was used as a proxy of CR and intracranial volume as a proxy of BR. Cognition was assessed across 5 domains (memory, attention, language, visuospatial, and executive functions). We performed multiple linear regression models to examine effects of CR and BR on cognitive domainZscores, adjusted for cerebral atrophy. Furthermore, we assessed differences in effects according to disease stage and across degrees of total reserve using a 4-level variable (high CR/high BR, high CR/low BR, low CR/high BR, and low CR/low BR).

RESULTS: We found positive, independent effects of both CR and BR across multiple cognitive domains. Stratification for disease stage showed that effects of CR on attention and executive functioning were greater in predementia than in dementia (β = 0.39 vs β = 0.21 [Welcht= 2.40,p< 0.01] and β = 0.46 vs β = 0.26 [t= 2.83,p< 0.01]). Furthermore, we found a linear trend for better cognitive performance in all domains in the high CR/high BR group, followed by high CR/low BR, low CR/high BR, and then low CR/low BR (pfor trend <0.05).

CONCLUSIONS: CR and BR both independently mitigate cognitive symptoms in AD. The positive effect of CR is most strongly expressed in the predementia stages and the additive effects of high CR and BR are most beneficial.

Original languageEnglish
Pages (from-to)e149-e156
JournalNeurology
Volume90
Issue number2
DOIs
Publication statusPublished - 9 Jan 2018

Cite this

@article{636f7a047b3d4f8098dea7d6def3a96e,
title = "Differential effects of cognitive reserve and brain reserve on cognition in Alzheimer disease",
abstract = "OBJECTIVE: To examine cross-sectional effects of cognitive reserve (CR) and brain reserve (BR) on cognition across the spectrum of Alzheimer disease (AD).METHODS: We included 663 AD biomarker-positive participants with dementia (probable AD, n = 462) or in the predementia stages (preclinical/prodromal AD, n = 201). Education was used as a proxy of CR and intracranial volume as a proxy of BR. Cognition was assessed across 5 domains (memory, attention, language, visuospatial, and executive functions). We performed multiple linear regression models to examine effects of CR and BR on cognitive domainZscores, adjusted for cerebral atrophy. Furthermore, we assessed differences in effects according to disease stage and across degrees of total reserve using a 4-level variable (high CR/high BR, high CR/low BR, low CR/high BR, and low CR/low BR).RESULTS: We found positive, independent effects of both CR and BR across multiple cognitive domains. Stratification for disease stage showed that effects of CR on attention and executive functioning were greater in predementia than in dementia (β = 0.39 vs β = 0.21 [Welcht= 2.40,p< 0.01] and β = 0.46 vs β = 0.26 [t= 2.83,p< 0.01]). Furthermore, we found a linear trend for better cognitive performance in all domains in the high CR/high BR group, followed by high CR/low BR, low CR/high BR, and then low CR/low BR (pfor trend <0.05).CONCLUSIONS: CR and BR both independently mitigate cognitive symptoms in AD. The positive effect of CR is most strongly expressed in the predementia stages and the additive effects of high CR and BR are most beneficial.",
keywords = "Journal Article",
author = "Colin Groot and {van Loenhoud}, {Anna C} and Frederik Barkhof and {van Berckel}, {Bart N M} and Teddy Koene and Teunissen, {Charlotte C} and Philip Scheltens and {van der Flier}, {Wiesje M} and Rik Ossenkoppele",
note = "Copyright {\circledC} 2017 American Academy of Neurology.",
year = "2018",
month = "1",
day = "9",
doi = "10.1212/WNL.0000000000004802",
language = "English",
volume = "90",
pages = "e149--e156",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Differential effects of cognitive reserve and brain reserve on cognition in Alzheimer disease

AU - Groot, Colin

AU - van Loenhoud, Anna C

AU - Barkhof, Frederik

AU - van Berckel, Bart N M

AU - Koene, Teddy

AU - Teunissen, Charlotte C

AU - Scheltens, Philip

AU - van der Flier, Wiesje M

AU - Ossenkoppele, Rik

N1 - Copyright © 2017 American Academy of Neurology.

PY - 2018/1/9

Y1 - 2018/1/9

N2 - OBJECTIVE: To examine cross-sectional effects of cognitive reserve (CR) and brain reserve (BR) on cognition across the spectrum of Alzheimer disease (AD).METHODS: We included 663 AD biomarker-positive participants with dementia (probable AD, n = 462) or in the predementia stages (preclinical/prodromal AD, n = 201). Education was used as a proxy of CR and intracranial volume as a proxy of BR. Cognition was assessed across 5 domains (memory, attention, language, visuospatial, and executive functions). We performed multiple linear regression models to examine effects of CR and BR on cognitive domainZscores, adjusted for cerebral atrophy. Furthermore, we assessed differences in effects according to disease stage and across degrees of total reserve using a 4-level variable (high CR/high BR, high CR/low BR, low CR/high BR, and low CR/low BR).RESULTS: We found positive, independent effects of both CR and BR across multiple cognitive domains. Stratification for disease stage showed that effects of CR on attention and executive functioning were greater in predementia than in dementia (β = 0.39 vs β = 0.21 [Welcht= 2.40,p< 0.01] and β = 0.46 vs β = 0.26 [t= 2.83,p< 0.01]). Furthermore, we found a linear trend for better cognitive performance in all domains in the high CR/high BR group, followed by high CR/low BR, low CR/high BR, and then low CR/low BR (pfor trend <0.05).CONCLUSIONS: CR and BR both independently mitigate cognitive symptoms in AD. The positive effect of CR is most strongly expressed in the predementia stages and the additive effects of high CR and BR are most beneficial.

AB - OBJECTIVE: To examine cross-sectional effects of cognitive reserve (CR) and brain reserve (BR) on cognition across the spectrum of Alzheimer disease (AD).METHODS: We included 663 AD biomarker-positive participants with dementia (probable AD, n = 462) or in the predementia stages (preclinical/prodromal AD, n = 201). Education was used as a proxy of CR and intracranial volume as a proxy of BR. Cognition was assessed across 5 domains (memory, attention, language, visuospatial, and executive functions). We performed multiple linear regression models to examine effects of CR and BR on cognitive domainZscores, adjusted for cerebral atrophy. Furthermore, we assessed differences in effects according to disease stage and across degrees of total reserve using a 4-level variable (high CR/high BR, high CR/low BR, low CR/high BR, and low CR/low BR).RESULTS: We found positive, independent effects of both CR and BR across multiple cognitive domains. Stratification for disease stage showed that effects of CR on attention and executive functioning were greater in predementia than in dementia (β = 0.39 vs β = 0.21 [Welcht= 2.40,p< 0.01] and β = 0.46 vs β = 0.26 [t= 2.83,p< 0.01]). Furthermore, we found a linear trend for better cognitive performance in all domains in the high CR/high BR group, followed by high CR/low BR, low CR/high BR, and then low CR/low BR (pfor trend <0.05).CONCLUSIONS: CR and BR both independently mitigate cognitive symptoms in AD. The positive effect of CR is most strongly expressed in the predementia stages and the additive effects of high CR and BR are most beneficial.

KW - Journal Article

U2 - 10.1212/WNL.0000000000004802

DO - 10.1212/WNL.0000000000004802

M3 - Article

VL - 90

SP - e149-e156

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 2

ER -