Active Cognitive Lifestyle Associates with Cognitive Recovery and a Reduced Risk of Cognitive Decline

Abstract

Education and lifestyle factors linked with complex mental activity are thought to affect the progression of cognitive decline. Collectively, these factors can be combined to create a cognitive reserve or cognitive lifestyle score. This study tested the association between cognitive lifestyle score and cognitive change in a population-based cohort of older persons from five sites across England and Wales. Data came from 13,004 participants of the Medical Research Council Cognitive Function and Ageing Study who were aged 65 years and over. Cognition was assessed at multiple waves over 16 years using the Mini-Mental State Examination. Subjects were grouped into four cognitive states (no impairment, slight impairment, moderate impairment, severe impairment) and cognitive lifestyle score was assessed as a composite measure of education, mid-life occupation, and current social engagement. A multi-state model was used to test the effect of cognitive lifestyle score on cognitive transitions. Hazard ratios for cognitive lifestyle score showed significant differences between those in the upper compared to the lower tertile with a more active cognitive lifestyle associating with: a decreased risk of moving from no to slight impairment (0.58, 95% CI (0.45, 0.74)); recovery from a slightly impaired state back to a non-impaired state (2.93 (1.35, 6.38)); but an increased mortality risk from a severely impaired state (1.28 (1.12, 1.45)). An active cognitive lifestyle is associated with a more favorable cognitive trajectory in older persons. Future studies would ideally incorporate neuroradiological and neuropathological data to determine if there is causal evidence for these associations.

The Natural History of Cervical Cancer in Chinese Women: Results from an 11-Year Follow-Up Study in China Using a Multistate Model

“…The valuable information provided by this method has been increasingly incorporated by health care providers into their clinical decision-making process (7,8). As the progression of cervical cancer is also a multistate process, it is well suited for the application of multistate modeling.…”

“…However, a dearth of studies on the natural development of cervical cancer exists in China. As the progression of cervical cancer is a long-term, multistate process, multistate model can be applied to describe the effect of carcinogenesis over time, which has been used in various fields (6)(7)(8)(9)(10)(11). At any given time during follow-up, the model classifies a subject into one of a finite number of distinct states and estimates the instantaneous rate of transition between states, probability of transition from one state to another within a specific time period, and mean sojourn time, defined as the average time spent in a state during a single stay.…”

Cognitive reserve in the healthy elderly: cognitive and psychological factors

“…Each of these factors encompasses one of several specific indicators that contribute to, or interact with, CR. Examples of such factors include literacy and education, occupation, regular complex mental activities, and cohesiveness of social networks [4][5][6][7][8]. It is also plausible that other variables, such as mood [9] and quality of sleep [10] may also determine cognitive performance in older age.…”

“…According to the model of Satz et al [3], complex mental activity, processing resources, and executive function represent core factors of CR. Complex mental activities ("cognitive lifestyle") represent a significant factor for CR because they are associated with more favorable cognitive trajectories in older persons [4,6] and may even support reversal from mild cognitive impairment (MCI) to normal cognitive functioning [18]. Accordingly, our main hypotheses were that (1) subjects with higher processing resources and higher executive capacities will show higher CR, and (2) CR is positively correlated with cognitive lifestyles, mood, well-being, and sleep quality.…”

Cognitive reserve: the evolution of the conceptual framework

“…Conversely, no difference in the survival's time was found in a-MCI patients with low CR and different level of baseline cognitive efficiency. Moreover, a longitudinal study in a large cohort of elderly showed that enriched cognitive life styles both reduced the risk of cognitive decline and improved the recovery of cognitive functions in the early stage of neurodegenerative diseases [33]. An association between complexity of occupation and successful In particular, in patients with high CR the onset of dementia is postponed compared to those with low CR [3].…”