The psychometric proprieties of CANE seem to be consistently good, in accordance with other studies. Robust results on ecological, face, content, criterion and construct validity, as well as good reliability, were achieved. This version is a promising tool for research and practical use in Portuguese old age settings.

Education and participation in leisure activities appear to be highly relevant variables in Alzheimer's disease (AD) and usually form the basis of the Cognitive Reserve construct.OBJECTIVE[A] To determine the association between education, cognitive and functional ability of AD patients; [B] To determine the association between participation in leisure activities and cognitive and functional ability of AD patients; [C] To evaluate the association of education and participation in leisure activities in the course of AD.METHODSFunctional and neuropsychological abilities of 120 outpatients with probable AD were evaluated at baseline, at 36 and 54 months. Data collected at baseline included socio-demographics, clinical variables, education and frequency of participation in leisure activities throughout life. All participants and/or caregivers answered the questionnaire, "Participation in leisure activities throughout life" while patients completed the MMSE, the Clinical Dementia Rating scale, neuropsychological tests from the Lisbon Screening for Dementia Assessment, Barthel Index and Lawton and Brody's Index.RESULTSAD patients with higher levels of education achieved better results on cognitive tests. The participants with higher participation in leisure activities exhibited better results on cognitive and functional tests than those with lower participation. The disease progression was linear and progressed similarly regardless of the level of education of participants. However, the results suggest a slower disease progression in patients with a higher level of participation in leisure activities throughout their lives.CONCLUSIONAD patients with high education and high participation in leisure activities may benefit from a slower cognitive and functional decline after diagnosis of AD.

This study found an association between CR measures and education, occupation and participation in leisure activities. The CRQ seems to be a suitable instrument to measure CR in Portuguese populations.

Alzheimer's disease (AD) is the most common form of dementia in the elderly 1 and a clinical syndrome caused by neurodegeneration and characterized by a progressive deterioration in cognitive ability and capacity for independent living. The course of AD is not the same in every person, but symptoms seem to develop over the same general stages. Cognitive reserve (CR) is a hypothetical construct that has been used to inform of cognitive aging and describes the capacity of the adult brain to deal with the effects of the neurodegenerative process and to minimize the clinical manifestation of pathology of dementia that is probably the result of innate intelligence or life experience 2 . The CR hypothesis suggests that individual differences in the ability to cope with AD pathology 2,3 are consistent with the prediction that people with more reserve can cope with advancing AD pathology longer before it is expressed clinically 3,4,5 . CR is not fixed, but continues to evolve across the lifespan 5 . Variables pertaining to lifetime experience (education, occupation attainment and leisure activities) 4,5 are the most commonly used proxies for CR and help retain cognitive function in old age. Epidemiological studies suggest that lifelong experiences, including educational, occupational attainment and leisure activities (LA) in later life, can increase reserve 4 . Greater understanding of the concept of CR could lead to ABSTRACTAlzheimer´s disease (AD) is a clinical syndrome caused by neurodegeneration and characterized by a progressive deterioration in cognitive ability and capacity for independent living. Cognitive reserve (CR) describes the capacity of the adult brain to cope with the effects of the neurodegenerative process and to minimize the clinical manifestation of pathology of dementia. The aim of this study was to evaluate the association of CR and the severity of AD. Method: This study was cross-sectional. Functional and neuropsychological abilities of 75 outpatients with probable AD diagnosis were evaluated. Patients completed two questionnaires, "Participation in leisure activities throughout life" and CR Questionnaire. Result: The relationship between Clinical Dementia Rating (CDR) and the level of CR was statistically significant (likelihood ratio (LR), p = 0.015). Conclusion: The level of CR influenced the severity of dementia. This study suggests that AD patients with higher CR may benefit against cognitive decline after diagnosis of AD.Keywords: Alzheimer´s disease, cognitive reserve, education, leisure activities, lifelong occupation. RESUMODoença de Alzheimer (DA) é uma síndrome neurodegenerativa caracterizada por uma deterioração progressiva das capacidades cognitivas e das competências para uma vida independente. A reserva cognitiva (RC) descreve a capacidade do cérebro adulto em lidar com os efeitos deste processo neurodegenerativo e minimizar a manifestação clínica da patologia de demência. O objetivo deste trabalho foi avaliar a associação entre RC e a severidade da DA. Método: Este estudo foi tra...