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Li Y, Ren Y, Cong L, Hou T, Song L, Wang M, Wang X, Han X, Tang S, Zhang Q, Dekhtyar S, Wang Y, Du Y, Qiu C. Association of Lifelong Cognitive Reserve with Dementia and Mild Cognitive Impairment among Older Adults with Limited Formal Education: A Population-Based Cohort Study. Dement Geriatr Cogn Disord 2023; 52:258-266. [PMID: 37517389 PMCID: PMC10614281 DOI: 10.1159/000532131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 06/29/2023] [Indexed: 08/01/2023] Open
Abstract
INTRODUCTION Early-life educational attainment contributes to cognitive reserve (CR). We investigated the associations of lifelong CR with dementia and mild cognitive impairment (MCI) among older people with limited formal education. METHODS This population-based cohort study included 2,127 dementia-free participants (≥60 years; 59.4% women; 81.5% with no or elementary school) who were examined at baseline (August-December 2014) and follow-up (March-September 2018). Lifelong CR score at baseline was generated from six lifespan intellectual factors. Dementia, MCI, and their subtypes were defined according to the international criteria. Data were analyzed using Cox proportional-hazards models. RESULTS During the total of 8,330.6 person-years of follow-up, 101 persons were diagnosed with dementia, including 74 with Alzheimer's disease (AD) and 26 with vascular dementia (VaD). The high (vs. low) tertile of lifelong CR score was associated with multivariable-adjusted hazards ratios (95% confidence interval) of 0.28 (0.14-0.55) for dementia and 0.18 (0.07-0.48) for AD. The association between higher CR and reduced AD risk was significant in people aged 60-74 but not in those aged ≥75 years (p for interaction = 0.011). Similarly, among MCI-free people at baseline (n = 1,635), the high (vs. low) tertile of lifelong CR score was associated with multivariable-adjusted hazard ratios of 0.51 (0.38-0.69) for MCI and 0.46 (0.33-0.64) for amnestic MCI. Lifelong CR was not related to VaD or non-amnestic MCI. DISCUSSION High lifelong CR is associated with reduced risks of dementia and MCI, especially AD and amnestic MCI. It highlights the importance of lifelong CR in maintaining late-life cognitive health even among people with no or limited education.
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Affiliation(s)
- Yuanjing Li
- Aging Research Center and Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
- Department of Neurology, Shandong Provincial Hospital, Jinan, PR China
| | - Yifei Ren
- Department of Neurology, Shandong Provincial Hospital, Jinan, PR China
- Cheeloo College of Medicine, Shandong University, Jinan, PR China
| | - Lin Cong
- Department of Neurology, Shandong Provincial Hospital, Jinan, PR China
| | - Tingting Hou
- Department of Neurology, Shandong Provincial Hospital, Jinan, PR China
| | - Lin Song
- Department of Neurology, Shandong Provincial Hospital, Jinan, PR China
| | - Mingqi Wang
- Department of Neurology, Shandong Provincial Hospital, Jinan, PR China
| | - Xiang Wang
- Department of Neurology, Shandong Provincial Hospital, Jinan, PR China
| | - Xiaojuan Han
- Department of Neurology, Shandong Provincial Hospital, Jinan, PR China
| | - Shi Tang
- Department of Neurology, Shandong Provincial Hospital, Jinan, PR China
| | - Qinghua Zhang
- Department of Neurology, Shandong Provincial Hospital, Jinan, PR China
| | - Serhiy Dekhtyar
- Aging Research Center and Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
| | - Yongxiang Wang
- Department of Neurology, Shandong Provincial Hospital, Jinan, PR China
| | - Yifeng Du
- Department of Neurology, Shandong Provincial Hospital, Jinan, PR China
- Cheeloo College of Medicine, Shandong University, Jinan, PR China
| | - Chengxuan Qiu
- Aging Research Center and Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
- Department of Neurology, Shandong Provincial Hospital, Jinan, PR China
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