背景:当面对大脑老化和损伤时,认知储备(CR)有助于保持认知。CR与晚年的痴呆风险有关。然而,CR与认知变化和脑成像测量之间的关联,尤其是在中年时期,不清楚。
目的:我们旨在探讨中老年人认知功能减退和脑结构差异与CR的关系。
方法:这项纵向研究来自英国生物库项目,参与者在2006年至2010年之间完成了基线调查,并进行了随访(平均随访:9年)。
方法:一项基于人群的研究。
方法:对42,301名年龄在40-70岁之间的无痴呆参与者进行随访,以检测认知变化。一个子样本(n=34,041)接受了脑部磁共振成像扫描。
方法:我们使用潜在类别分析来生成CR指标(分类为高,中度,和低)基于教育,职业,和多种认知刺激活动。在基线和随访时进行了针对全球和特定领域认知的认知测试。全脑,白质,灰质,海马,和白质高强度体积(TBV,WMV,GMV,HV,和WMHV)在随访检查中进行评估。使用混合效应模型和协方差分析对数据进行分析。
结果:在基线时,16,032(37.9%),10,709(25.3%),15560名(36.8%)参与者的发病率较低,中度,和高水平的CR,分别。与低CR相比,高CR与全球认知下降较慢相关(β[95%置信区间]:0.10[0.08,0.11]),预期记忆(0.10[0.06,0.15]),流体智能(0.07[0.04,0.10]),和反应时间(0.04[0.02,0.06])。高CR的参与者有较低的TBV,WMV,GMV,和WMHV,但控制整体认知时HV较高(校正P<0.01)。在中年(<60岁)和老年(≥60岁)参与者中,CR与认知和TBV之间存在显着关系。尽管大脑结构特性降低,但CR-认知关联仍然显着。
结论:较高的CR与较慢的认知下降有关,较高的HV,降低微血管负担,尤其是在中年。具有高CR的个体可以在维持认知的同时耐受较小的脑体积。CR对认知的益处与脑结构差异无关。我们的发现强调了增强CR对帮助补偿神经影像学改变并最终防止认知能力下降的贡献。
BACKGROUND: Cognitive reserve (CR) contributes to preserving cognition when facing brain aging and damage. CR has been linked to dementia risk in late life. However, the association between CR and cognitive changes and brain imaging measures, especially in midlife, is unclear.
OBJECTIVE: We aimed to explore the association of CR with cognitive decline and structural brain differences in middle and older age.
METHODS: This longitudinal study was from the UK Biobank project where participants completed baseline surveys between 2006 to 2010 and were followed (mean follow-up: 9 years).
METHODS: A population-based study.
METHODS: A total of 42,301 dementia-free participants aged 40-70 were followed-up to detect cognitive changes. A subsample (n=34,041) underwent brain magnetic resonance imaging scans.
METHODS: We used latent class analysis to generate a CR indicator (categorized as high, moderate, and low) based on education, occupation, and multiple cognitively stimulating activities. Cognitive tests for global and domain-specific cognition were administrated at baseline and follow-up. Total brain, white matter, grey matter, hippocampal, and white matter hyperintensity volumes (TBV, WMV, GMV, HV, and WMHV) were assessed at the follow-up examination. Data were analyzed using mixed-effects models and analysis of covariance.
RESULTS: At baseline, 16,032 (37.9%), 10,709 (25.3%), and 15,560 (36.8%) participants had low, moderate, and high levels of CR, respectively. Compared with low CR, high CR was associated with slower declines in global cognition (β [95% confidence interval]: 0.10 [0.08, 0.11]), prospective memory (0.10 [0.06, 0.15]), fluid intelligence (0.07 [0.04, 0.10]), and reaction time (0.04 [0.02, 0.06]). Participants with high CR had lower TBV, WMV, GMV, and WMHV, but higher HV when controlling for global cognition (corrected P <0.01 for all). The significant relationships between CR and cognition and TBV were present among both middle-aged (<60 years) and older (≥60 years) participants. The CR-cognition association remained significant despite reductions in brain structural properties.
CONCLUSIONS: Higher CR is associated with slower cognitive decline, higher HV, and lower microvascular burden, especially in middle age. Individuals with high CR could tolerate smaller brain volumes while maintaining cognition. The benefit of CR for cognition is independent of structural brain differences. Our findings highlight the contribution of enhancing CR to helping compensate for neuroimaging alterations and ultimately prevent cognitive decline.