Cognitive Trajectories and Dementia Risk: A Comparison of Two Cognitive Reserve Measures

Background and Objectives

Cognitive reserve (CR) is meant to account for the mismatch between brain damage and cognitive decline or dementia. Generally, CR has been operationalized using proxy variables indicating exposure to enriching activities (activity-based CR). An alternative approach defines CR as residual variance in cognition, not explained by the brain status (residual-based CR). The aim of this study is to compare activity-based and residual-based CR measures in their association with cognitive trajectories and dementia. Furthermore, we seek to examine if the two measures modify the impact of brain integrity on cognitive trajectories and if they predict dementia incidence independent of brain status.

Methods

We used data on 430 older adults aged 60+ from the Swedish National Study on Aging and Care in Kungsholmen, followed for 12 years. Residual-based reserve was computed from a regression predicting episodic memory with a brain-integrity index incorporating six structural neuroimaging markers (white-matter hyperintensities volume, whole-brain gray matter volume, hippocampal volume, lateral ventricular volume, lacunes, and perivascular spaces), age, and sex. Activity-based reserve incorporated education, work complexity, social network, and leisure activities. Cognition was assessed with a composite of perceptual speed, semantic memory, letter-, and category fluency. Dementia was clinically diagnosed in accordance with DSM-IV criteria. Linear mixed models were used for cognitive change analyses. Interactions tested if reserve measures modified the association between brain-integrity and cognitive change. Cox proportional hazard models, adjusted for brain-integrity index, assessed dementia risk.

Results

Both reserve measures were associated with cognitive trajectories [β × time (top tertile, ref.: bottom tertile) = 0.013; 95% CI: –0.126, –0.004 (residual-based) and 0.011; 95% CI: –0.001, 0.024, (activity-based)]. Residual-based, but not activity-based reserve mitigated the impact of brain integrity on cognitive decline [β (top tertile × time × brain integrity) = –0.021; 95% CI: –0.043, 0.001] and predicted 12-year dementia incidence, after accounting for the brain-integrity status [HR (top tertile) = 0.23; 95% CI: 0.09, 0.58].

Interpretation

The operationalization of reserve based on residual cognitive performance may represent a more direct measure of CR than an activity-based approach. Ultimately, the two models of CR serve largely different aims. Accounting for brain integrity is essential in any model of reserve.

The Risk of Dementia in Relation to Cognitive and Brain Reserve

Background:

Individual differences in the risk to develop dementia remain poorly understood. These differences may partly be explained through reserve, which is the ability to buffer cognitive decline due to neuropathology and age.

Objective:

To determine how much early and late–life cognitive reserve (CR) and brain reserve (BR) contribute to the risk of dementia.

Methods:

4,112 dementia-free participants (mean age = 66.3 years) from the Rotterdam Study were followed up for on average 6.0 years. Early-life CR and BR were defined as attained education and intracranial volume, respectively. Late-life CR was derived through variance decomposition based on cognition. Late-life BR was set as the total non-lesioned brain volume divided by intracranial volume.

Results:

Higher early-life CR (hazard ratio = 0.48, 95% CI = [0.21; 1.06]) but not early-life BR associated with a lower risk of incident dementia. Higher late-life CR (hazard ratio = 0.57, 95% CI = [0.48; 0.68]) and late-life BR (hazard ratio = 0.54, 95% CI = [0.43; 0.68]) also showed lower levels of dementia. Combining all proxies into one model attenuated the association between early-life CR and dementia (hazard ratio = 0.56, 95% CI = [0.25; 1.25]) whereas the other associations were unaffected. These findings were stable upon stratification for sex, age, and APOEɛ4. Finally, high levels of late-life CR and BR provided additive protection against dementia.

Conclusion:

The findings illustrate the importance of late-life over early-life reserve in understanding the risk of dementia, and show the need to study CR and BR conjointly.

Studying at university in later life slows cognitive decline: A long-term prospective study

INTRODUCTION

Declining cognition in later life is associated with loss of independence and quality of life. This decline in cognition may potentially be reduced or reversed through engaging in cognitively stimulating activities. This study examined the potential for university attendance in later life to enhance cognitive function in older adults.

METHODS

Cognitively unimpaired adults (n = 485, 69% female, median age 60 years) were given the opportunity to undertake free university study. Repeated neurocognitive assessment was performed over 7 years.

RESULTS

Participants in the university education group (n = 383) improved z = .02 SD (.01, .03) per year of the study compared to controls (P = .001; averaged across a battery of cognitive tests). The largest improvements were observed on tests of language and verbal learning, memory, and episodic memory.

DISCUSSION

Later-life university study was associated with improved cognitive trajectories. Later-life education may preserve cognitive function, specifically for functions associated with communication, social interaction, and maintaining independence.

Impact of occupational complexity on cognitive decline in the oldest-old

OBJECTIVES

The theory of "Cognitive Reserve" assumes that premorbid factors such as high educational and occupational attainment may enable a better way of coping with brain damage. It has been suggested that more stimulating lifestyles, including more complex work environments, may provide a buffer against cognitive decline in later life. This study aimed to investigate the association between occupational history and cognitive decline in a large cohort of Italian oldest-old.

METHODS

392 individuals (266 women/126 men, mean age 93 ± 3 years) enrolled in the "Mugello study" provided information about their work history. Jobs were classified in nine categories, according to the level of expertise required to perform them, as suggested by the Italian National Institute for Statistics (ISTAT). In addition, socio-demographic characteristics, comorbidities, level of independence, depression, and cognitive status were assessed. The presence of dementia was established based on cognitive status and independence in performing four selected instrumental activities of daily living (ability to manage telephone, transportation, medications, and budget).

RESULTS

Neither work complexity (p = 0.995) nor work duration (p = 0.701) showed a significant effect on the likelihood of presenting a lower cognitive profile or developing dementia (p = 0.385 and p = 0.096, for work complexity and work duration, respectively).

CONCLUSION

In the observed sample of oldest-old individuals, cognitive decline did not seem to be influenced by cognitive reserve as assessed through the evaluation of cognitive status and level of independence. It is conceivable that in this population, the decline of the brain reserve has a preponderant role in the definition of the cognitive profile.

Changes in Default Mode Network Connectivity in Resting-State fMRI in People with Mild Dementia Receiving Cognitive Stimulation Therapy

Group cognitive stimulation therapy (CST) is a 7-week activity-based non-pharmacological intervention for people with mild to moderate dementia. Despite consistent evidence of clinical efficacy, the cognitive and brain mechanisms of CST remain unclear. Theoretically, group CST as a person-centred approach may work through promoting social interaction and personhood, executive function, and language use, especially in people with higher brain/cognitive reserve. To explore these putative mechanisms, structural MRI and resting-state functional MRI data were collected from 16 people with mild dementia before and after receiving CST, and in 13 dementia controls who received treatment as usual (TAU). Voxel-based morphometry (VBM) and resting-state functional connectivity (rs-FC) analyses were performed. Compared with TAU, the CST group maintained the total brain volume/total intracranial volume (TBV/TICV) ratio. Increased rs-FC in the default mode network (DMN) in the posterior cingulate cortex and bilateral parietal cortices nodes was observed in the CST over TAU groups between pre- and post-intervention timepoints. We provided preliminary evidence that CST maintains/enhances brain reserve both structurally and functionally. Considering the role of DMN in episodic memory retrieval and mental self-representation, preservation of personhood may be an important mechanism of CST for further investigation.

Association Between Components of Cognitive Reserve and Serum BDNF in Healthy Older Adults

Background: The brain-derived neurotrophic factor (BDNF) protein has been shown to have a prominent role in neuron survival, growth, and function in experimental models, and the BDNF Val66Met polymorphism which regulates its expression has been linked to resilience toward the effects of aging on cognition. Cognitively stimulating activity is linked to both increased levels of BDNF in the brain, and protection against age-related cognitive decline. The aim of this study was to investigate the associations between serum BDNF levels, the BDNF Val66Met genotype, and components of cognitive reserve in early and mid-life, measured with the Lifetime of Experiences Questionnaire (LEQ). Methods: Serum BDNF levels were measured cross-sectionally in 156 participants from the Tasmanian Healthy Brain Project (THBP) cohort, a study examining the potential benefits of older adults engaging in a university-level education intervention. Multiple linear regression was used to estimate serum BDNF's association with age, education, gender, BDNF Val66Met genotype, later-life university-level study, and cognitively stimulating activities measured by the LEQ. Results: Serum BDNF in older adults was associated with early life education and training, increasing 0.007 log(pg/ml) [95%CI 0.001, 0.012] per unit on the LEQ subscale. Conversely, education and training in mid-life were associated with a -0.007 log(pg/ml) [-0.012, -0.001] decrease per unit on the LEQ subscale. Serum BDNF decreased with age (-0.008 log(pg/ml) [-0.015, -0.001] per year), and male gender (-0.109 log(pg/ml) [-0.203, -0.015]), but mean differences between the BDNF Val66Met polymorphisms were not significant (p = 0.066). All effect sizes were small, with mid-life education and training having the largest effect size ( η p 2 = 0.044). Conclusion: Education in both early and mid-life explained small but significant amounts of variance in serum BDNF levels, more than age or gender. These effects were opposed and independent, suggesting that education at different stages of life may be associated with different cognitive and neural demands. Education at different stages of life may be important covariates when estimating associations between other exposures and serum BDNF.

The higher, the better: Cognitive reserve contributes to lifestyle activities in older age

The study aimed at investigating age and gender differences in cognitive reserve (CR) and whether CR can contribute to everyday and physical activity and fluid reasoning in older adults. Participants (N = 294), categorized into three age groups: young-old, middle-old, and old-old, completed the Cognitive Reserve Index questionnaire (CRIq), the Everyday Activity Questionnaire (EAQ), the Physical Activity Scale for the Elderly (PASE), and the Unbalanced Structure Test (UST). The old-old had significantly lower scores on CRI-Total, CRI-Working activity, and CRI-Leisure time compared to young-old and middle-old. Men showed higher scores than women on all CR subscales except for CRI-Leisure time where no significant difference was found. Younger age and higher CRI-Leisure time predicted higher scores on PASE, EAQ, and UST, while higher scores on CRI-Education predicted EAQ and UST. Higher CR seems to enable a more active and healthier lifestyle, while CRIq is a useful tool in the assessment of cognitive potential in the elderly.

Education Moderates the Negative Effect of Apolipoprotein E ɛ4 on Response Inhibition in Older Adults

BACKGROUND

Studies have reported that apolipoprotein E epsilon 4 (APOE ɛ4) has adverse effects on executive functions (EFs) in late adulthood. However, the results have been inconsistent. Insufficient measurements of executive functioning, uncontrolled clinical and demographic confounders, and moderation effects from other environmental factors are suspected to account for the inconsistency.

OBJECTIVE

This study used aggregate measures to examine the effects of APOE ɛ4 on four components of EFs, namely switching, working memory, inhibition, and reasoning. We further investigated whether high educational attainment, a proxy measure for cognitive reserve, moderates the adverse effects of ɛ4 on EFs.

METHODS

Cognitively unimpaired older participants were divided into groups based on APOE genotype and into subgroups based on educational attainment level. The demographic and clinical variables were matched between the groups. Four core components of the EFs were measured using a relatively comprehensive battery.

RESULTS

The results revealed that although no main effect of the APOE genotype was observed across the four EF components, the potentially adverse effects of ɛ4 on inhibition were alleviated by high educational attainment. A main effect of education on the reasoning component was also observed. The moderation analysis revealed that for older adults with 12 years of education or fewer, the relationship between the APOE ɛ4 genotype and inhibition performance became increasingly negative.

CONCLUSION

This study highlights the distinctive role of response inhibition in the gene-environment interaction and underlines the importance of considering factors of both nature and nurture to understand the complex process of cognitive aging.

Sex differences in the behavioral variant of frontotemporal dementia: A new window to executive and behavioral reserve

INTRODUCTION

Biological sex is an increasingly recognized factor driving clinical and structural heterogeneity in Alzheimer's disease, but its role in the behavioral variant of frontotemporal dementia (bvFTD) is unknown.

METHODS

We included 216 patients with bvFTD and 235 controls with magnetic resonance imaging (MRI) from a large multicenter cohort. We compared the clinical characteristics and cortical thickness between men and women with bvFTD and controls. We followed the residuals approach to study behavioral and cognitive reserve.

RESULTS

At diagnosis, women with bvFTD showed greater atrophy burden in the frontotemporal regions compared to men despite similar clinical characteristics. For a similar amount of atrophy, women demonstrated better-than-expected scores on executive function and fewer changes in apathy, sleep, and appetite than men.

DISCUSSION

Our findings suggest that women might have greater behavioral and executive reserve than men, and neurodegeneration must be more severe in women to produce symptoms similar in severity to those in men.

Engagement in cognitively stimulating activities in individuals with Mild Cognitive Impairment: relationships with neuropsychological domains and hippocampal volume

Late-life participation in cognitively stimulating activities is thought to contribute to an individual's cognitive reserve and thus protect against cognitive decline, yet its association with clinical markers of neurodegeneration is not well established. To investigate, we developed a 13-item self-report "cognitively stimulating activities" questionnaire (CSA-Q), which was completed by a community sample of 269 older adults (>50 years) at risk of dementia. Participants met criteria for Mild Cognitive Impairment (MCI) and were classified as amnestic (aMCI; n = 93) or non-amnestic (naMCI; n = 176). Weighted CSA-Q dimensions were calculated for activity intensity, mental engagement and social engagement via a panel of 23 inter-raters. The CSA-Q mean and its dimensions were examined in relation to: (a) demographics (age, sex), (b) cognitive reserve proxies (years of education, premorbid IQ), (c) neuropsychological markers across cognitive domains of executive function, processing speed, learning, and memory storage, and (d) neuroimaging markers (left and right hippocampal volume). Analyses were conducted for all MCI, as well as for aMCI and naMCI sub-types. The CSA-Q was found to have concurrent validity with cognitive reserve proxies. Among all MCI, the CSA-Q dimensions of intensity and mental engagement had moderate associations with left hippocampal volume, but not with neuropsychological performance. For naMCI, the CSA-Q had moderate associations with left hippocampal volume, and small associations with aspects of executive functioning and processing speed. No equivalent associations emerged for the aMCI subtype. Our findings show that the CSA-Q may be particularly useful for older adults with non-amnestic cognitive deficits.

Cognitive Reserve, Executive Function, and Memory in Parkinson's Disease

Cognitive impairment is acknowledged as a feature of Parkinson’s disease (PD), and the most common cognitive declines are in executive function (EF) and memory. Cognitive reserve (CR) may offer some protection against cognitive dysfunction in PD. The present study used two proxies of CR (years of education, premorbid IQ) to examine the relationship between CR and (i) EF (ii) memory in a large PD sample (n = 334). Two aspects of EF were examined, including verbal fluency and planning skills. Two aspects of verbal memory were examined, including immediate recall and delayed recall. For EF, both CR proxies significantly predicted verbal fluency, but only years of education predicted planning skills. Years of education significantly predicted immediate recall, but premorbid IQ did not. Neither CR proxy predicted delayed recall. These findings suggest that CR, in particular years of education, may contribute to EF and memory function in those with PD. A key finding of this study is the varying contribution of CR proxies to different aspects of the same cognitive domain. The findings indicate that using only one proxy has the potential to be misleading and suggest that when testing the relationship between CR and cognition, studies should include tasks that measure different aspects of the cognitive domain(s) of interest.

Women Exhibit Lower Global Left Frontal Cortex Connectivity Among Cognitively Unimpaired Elderly Individuals: A Pilot Study from SILCODE

BACKGROUND

Mounting evidence suggests that sex differences exist in cognitive reserve (CR) for cognitively unimpaired (CU) elderly individuals. Global left frontal connectivity (gLFC connectivity) is a reliable neural substrate of CR.

OBJECTIVE

The purpose of this study was to explore sex differences in gLFC connectivity among CU elderly individuals.

METHODS

One hundred thirteen normal controls (NCs) (women = 66) and 132 individuals with subjective cognitive decline (SCD) (women = 92) were recruited from the Sino Longitudinal Study on Cognitive Decline (SILCODE) (data 1). Among them, 88 subjects underwent amyloid-β (Aβ) imaging, including 32 Aβ+ and 56 Aβ-subjects. Forty-six subjects underwent another rs-fMRI examination (data 2) to validate the repeatability of the calculation of gLFC connectivity, which was determined through seed-based functional connectivity between the LFC and voxels throughout the whole brain. Independent-sample t-tests were used to evaluate the sex differences in gLFC connectivity across different subgroups (NC versus SCD, Aβ+ versus Aβ-). Partial correlation analysis was used to calculate the correlations between gLFC connectivity and cognitive assessments.

RESULTS

Women exhibited lower gLFC connectivity in both the NC (p = 0.001) and SCD (p = 0.020) subgroups than men. Women also exhibited lower gLFC connectivity in both the Aβ-(p = 0.006) and Aβ+ (p = 0.025) groups. However, the significant difference disappeared in the Aβ+ group when considering the covariates of age, education, total intracranial volume, and APOE4-carrying status. In addition, gLFC connectivity values were negatively correlated with Geriatric Depression Scale scores in the SCD group (r = -0.176, p = 0.047).

CONCLUSION

Women showed lower gLFC connectivity among CU elderly individuals.

Sex Differences in Locus Coeruleus: A Heuristic Approach That May Explain the Increased Risk of Alzheimer's Disease in Females

This article aims to reevaluate our approach to female vulnerability to Alzheimer's disease (AD) and put forth a new hypothesis considering how sex differences in the locus coeruleus-noradrenaline (LC-NA) structure and function could account for why females are more likely to develop AD. We specifically focus our attention on locus coeruleus (LC) morphology, the paucity of estrogens, neuroinflammation, blood-brain barrier permeability, apolipoprotein ɛ4 polymorphism (APOEɛ4), and cognitive reserve. The role of the LC-NA system and sex differences are two of the most rapidly emerging topics in AD research. Current literature either investigates the LC due to it being one of the first brain areas to develop AD pathology or acknowledges the neuroprotective effects of estrogens and how the loss of these female hormones have the capacity to contribute to the sex differences seen in AD; however, existing research has neglected to concurrently examine these two rationales and therefore leaving our hypothesis undetermined. Collectively, this article should assist in alleviating current challenges surrounding female AD by providing thought-provoking connections into the interrelationship between the disruption of the female LC-NA system, the decline of estrogens, and AD vulnerability. It is therefore likely that treatment for this heterogeneous disease may need to be distinctly developed for females and males separately, and may require a precision medicine approach.

Bilingual experience and intrinsic functional connectivity in adults, aging, and Alzheimer's disease

The past decade marked the beginning of the use of resting-state functional connectivity (RSFC) imaging in bilingualism studies. This paper intends to review the latest evidence of changes in RSFC in language and cognitive control networks in bilinguals during adulthood, aging, and early Alzheimer's disease, which can add to our understanding of brain functional reshaping in the context of second language (L2) acquisition. Because of high variability in bilingual experience, recent studies mostly focus on the role of the main aspects of bilingual experience (age of acquisition (AoA), language proficiency, and language usage) on intrinsic functional connectivity (FC). Existing evidence accounts for stronger FC in simultaneous rather than sequential bilinguals in language and control networks, and the modulation of the AoA impact by language proficiency and usage. Studies on older bilingual adults show stronger FC in language and frontoparietal networks and preserved FC in posterior brain regions, which can protect the brain against cognitive decline and neurodegenerative processes. Altered RSFC in language and control networks subsequent to L2 training programs also is associated with improved global cognition in older adults. This review ends with a brief discussion of potential confounding factors in bilingualism research and conclusions and suggestions for future research.

Person-Based Similarity Index for Cognition and Its Neural Correlates in Late Adulthood: Implications for Cognitive Reserve

Healthy aging is typically associated with some level of cognitive decline, but there is substantial variation in such decline among older adults. The mechanisms behind such heterogeneity remain unclear but some have suggested a role for cognitive reserve. In this work, we propose the "person-based similarity index" for cognition (PBSI-Cog) as a proxy for cognitive reserve in older adults, and use the metric to quantify similarity between the cognitive profiles of healthy older and younger participants. In the current study, we computed this metric in 237 healthy older adults (55-88 years) using a reference group of 156 younger adults (18-39 years) taken from the Cambridge Center for Ageing and Neuroscience dataset. Our key findings revealed that PBSI-Cog scores in older adults were: 1) negatively associated with age (rho = -0.25, P = 10-4) and positively associated with higher education (t = 2.4, P = 0.02), 2) largely explained by fluid intelligence and executive function, and 3) predicted more by functional connectivity between lower- and higher-order resting-state networks than brain structural morphometry or education. Particularly, we found that higher segregation between the sensorimotor and executive networks predicted higher PBSI-Cog scores. Our results support the notion that brain network functional organization may underly variability in cognitive reserve in late adulthood.

Electrophysiological Proxy of Cognitive Reserve Index

Cognitive reserve (CR) postulates that individual differences in task performance can be attributed to differences in the brain’s ability to recruit additional networks or adopt alternative cognitive strategies. Variables that are descriptive of lifetime experience such as socioeconomic status, educational attainment, and leisure activity are common proxies of CR. CR is mostly studied using neuroimaging techniques such as functional MRI (fMRI) in which case individuals with a higher CR were observed to activate a smaller brain network compared to individuals with a lower CR, when performing a task equally effectively (higher efficiency), and electroencephalography (EEG) where a particular EEG component (P300) that reflects the attention and working memory load, has been targeted. Despite the contribution of multiple factors such as age, education (formal and informal), working, leisure, and household activities in CR formation, most neuroimaging studies, and those using EEG in particular, focus on formal education level only. The aim of the current EEG study is to investigate how the P300 component, evoked in response to an oddball paradigm, is associated with other components of CR besides education, such as working and leisure activity in older adults. We have used hereto a recently introduced CR index questionnaire (CRIq) that quantifies both professional and leisure activities in terms of their cognitive demand and number of years practiced, as well as a data-driven approach for EEG analysis. We observed complex relationships between CRIq subcomponents and P300 characteristics. These results are especially important given that, unlike previous studies, our measurements (P300 and CRIq) do not require active use of the same executive function and, thus, render our results free of a collinearity bias.

Functional Connectivity and Compensation of Phonemic Fluency in Aging

Neural compensatory mechanisms associated with broad cognitive abilities have been studied. However, those associated with specific cognitive subdomains (e.g., verbal fluency) remain to be investigated in healthy aging. Here, we delineate: (a) neural substrates of verbal (phonemic) fluency, and (b) compensatory mechanisms mediating the association between these neural substrates and phonemic fluency. We analyzed resting-state functional magnetic resonance imaging from 133 right-handed, cognitively normal individuals who underwent the Controlled Oral Word Association Test (COWAT) to record their phonemic fluency. We evaluated functional connectivity in an established and extended language network comprising Wernicke, Broca, thalamic and anti-correlated modules. (a) We conducted voxel-wise multiple linear regression to identify the brain areas associated with phonemic fluency. (b) We used mediation effects of cognitive reserve, measured by the Wechsler Adult Intelligence Scale—Information subtest, upon the association between functional connectivity and phonemic fluency tested to investigate compensation. We found that: (a) Greater functional connectivity between the Wernicke module and brain areas within the anti-correlated module was associated with better performance in phonemic fluency, (b) Cognitive reserve was an unlikely mediator in younger adults. In contrast, cognitive reserve was a partial mediator of the association between functional connectivity and phonemic fluency in older adults, likely representing compensation to counter the effect of aging. We conclude that in healthy aging, higher performance in phonemic fluency at older ages could be attributed to greater functional connectivity partially facilitated by higher cognitive reserve, presumably reflecting compensatory mechanisms to minimize the effect of aging.

Cognitive reserve and the effects of virtual reality-based cognitive training on elderly individuals with mild cognitive impairment and normal cognition

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.

Impact of Cognitive Reserve and Premorbid IQ on Cognitive and Functional Status in Older Outpatients

The study aimed to investigate cross-sectionally the associations of cognitive reserve (CR) and premorbid IQ with cognitive and functional status in a cohort of older outpatients. Additionally, we evaluated the association of CR and premorbid IQ with the worsening of patients' cognitive status at one-year follow-up. We originally included 141 outpatients (mean age 80.31 years); a telephone-based cognitive follow-up was carried out after one year, including 104 subjects (mean age 80.26 years). CR (β = 0.418), premorbid IQ (β = 0.271) and handgrip strength (β = 0.287) were significantly associated with the MMSE score. The cognitive worsening at follow-up was associated with lower CR, lower MMSE score, reduced gait speed and frailty exhibited at baseline. Univariate linear regressions showed that CR was associated with handgrip strength (β = 0.346), gait speed (β = 0.185), autonomy in basic (β = 0.221) and instrumental (β = 0.272) daily activities, and frailty (β = -0.290); premorbid IQ was significantly associated with autonomy in instrumental daily activities (β = 0.211). These findings highlight the need for integrating CR and premorbid IQ with physical and motor measures when appraising predictors of cognitive decline in the elderly population. The study also newly extends the link of CR and premorbid IQ to the functional status in older adults.

Oestrogen treatment modulates the impact of cognitive experience and task complexity on memory in middle-aged surgically menopausal rats

Menopause has been linked to changes in memory. Oestrogen-containing hormone therapy is prescribed to treat menopause-related symptoms and can ameliorate memory changes, although the parameters impacting oestrogen-related memory efficacy are unclear. Cognitive experience and practice have been shown to be neuroprotective and to improve learning and memory during ageing, with the type of task playing a role in subsequent cognitive outcomes. Whether task complexity matters, and whether these outcomes interact with menopause and oestrogen status, remains unknown. To investigate this, we used a rat model of surgical menopause to systematically assess whether maze task complexity, as well as order of task presentation, impacts spatial learning and memory during middle age when rats received vehicle, low-17β-oestradiol (E2 ) or high-E2 treatment. The direction, and even presence, of the effects of prior maze experience differed depending on the E2 dose. Surgical menopause without E2 treatment yielded the least benefit, as prior maze experience did not have a substantial effect on subsequent task performance for vehicle treated rats regardless of task demand level during the first exposure to maze experience or final testing. High-dose E2 yielded a variable benefit, and low-dose E2 produced the greatest benefit. Specifically, low-dose E2 broadly enhanced learning and memory in surgically menopausal rats that had prior experience on another task, regardless of the complexity level of this prior experience. These results demonstrate that E2 dose influences the impact of prior cognitive experience on learning and memory during ageing, and highlights the importance of prior cognitive experience in subsequent learning and memory outcomes.

Sex Difference in Network Topology and Education Correlated With Sex Difference in Cognition During the Disease Process of Alzheimer

Background: Alzheimer's disease (AD) manifests differently in males and females. However, the neuro-mechanism and influence factors are still unknown. Objective: To explore sex differences in brain network topology during AD disease progression and its association with cognition and possible influencing factors. Methods: Resting-state functional magnetic resonance imaging (MRI) data and cognitive scores were collected from 82 AD patients (50 females), 56 amnestic mildly cognitive impaired patients (29 females), and 63 healthy controls (38 females). Global and regional topological network metrics and modular architecture were calculated. Two-way ANOVA was performed to explore group and sex interactions and their main effects. Mediation analysis was used to explore the relationship among education, inter/intra-network connectivity, and the Mini-Mental State Examination (MMSE) score. Results: Lower levels of education, lower MMSE scores, and a positive correlation between the level of education and MMSE scores were found in female AD patients (p = 0.024, r = 0.319). Significantly lower connectivity strength within the sensorimotor network, dorsal attention network, ventral attention network (VAN), and between the sensorimotor and VAN were observed in male AD patients (p = 0.006, 0.028, 0.046, and 0.013, respectively). Group and sex interactions were also found in nodal properties, mainly in the frontal lobe, temporal lobe, middle cingulum, precuneus, and postcentral gyrus. Several of the altered brain network properties were associated with cognitive behavior in male AD patients. Education regulated the MMSE score through the mediation of connection strength between the default mode and limbic networks (LN) in the patient group (aMCI and AD combined). Conclusion: Our results demonstrate that sex differences exist at the brain network level in AD. Sex differences in network topology and education are correlated with sex differences in cognition during AD progression.

[Episodic memory and aging: The role of cognitive reserve and cognitive resources according to task difficulty]

BACKGROUND

Episodic memory is the most affected memory system in aging. However, memory decline is not similar in every older adult. Various cognitive reserve factors, as Openness personality trait or educational level, and cognitive resources linked to these factors, as executive control and crystallized knowledge, can predict older adults' memory performance.

OBJECTIVE

This study examined the link between and the role of these variables in older adults' memory performances according to the task difficulty.

METHODS

Forty participants (60-82 years old) learned 24 paired words with two encoding conditions (reading and generation) and then performed a cued recall. Their educational level was asked, and their Openness, executive control and crystallized knowledge levels were respectively measured using a personality questionnaire (Big Five), an inhibition test (Stroop) and a vocabulary test (Mill Hill).

RESULTS

Only crystallized knowledge predicts older adults' generated words recall while Openness and executive control predict and mediate educational level effect on older adults' read words recall.

CONCLUSION

Openness is a reserve factor and is an essential component, along with executive control, in difficult memory tasks.

An Effect of Education on Memory-Encoding Activation in Subjective Cognitive Decline

BACKGROUND

Subjective cognitive decline (SCD) may be an early manifestation of pre-clinical Alzheimer's disease. Elevated amyloid-β (Aβ) is a correlate of SCD symptoms in some individuals. The underlying neural correlates of SCD symptoms and their association with Aβ is unknown. SCD is a heterogeneous condition, and cognitive reserve may explain individual differences in its neural correlates.

OBJECTIVE

We investigated the association between brain activation during memory encoding and SCD symptoms, as well as with Aβ, among older individuals. We also tested the moderating role of education (an index of cognitive reserve) on the associations.

METHODS

We measured brain activation during the "face-name" memory-encoding fMRI task and Aβ deposition with Pittsburgh Compound-B (PiB)-PET among cognitively normal older individuals (n = 63, mean age 73.1 ± 7.4 years). We tested associations between activation and SCD symptoms by self-report measures, Aβ, and interactions with education.

RESULTS

Activation was not directly associated with SCD symptoms or Aβ. However, education moderated the association between activation and SCD symptoms in the executive control network, salience network, and subcortical regions. Greater SCD symptoms were associated with greater activation in those with higher education, but with lower activation in those with lower education.

CONCLUSION

SCD symptoms were associated with different patterns of brain activation in the extended memory system depending on level of cognitive reserve. Greater SCD symptoms may represent a saturation of neural compensation in individuals with greater cognitive reserve, while it may reflect diminishing neural resources in individuals with lower cognitive reserve.