Protective factors for subjective cognitive decline individuals: trajectories and changes in a longitudinal study with Italian elderly

Abstract

Background and purpose Many different factors have been hypothesized to modulate cognition in an aging population according to their functioning at baseline. Methods This retrospective study quantifies the relative contribution of age and sex as demographic factors, comorbidity, education and occupation (classified with the International Standard Classification of Occupation 2008) as cognitive reserve proxies in accounting for cognitive aging. All participants (3081) were evaluated at baseline with a complete neuropsychological test battery (T1) and those with unimpaired profiles were classified as subjective cognitive decline, those mildly impaired as mild neurocognitive decline and those severely impaired as major neurocognitive decline. From the first assessment 543 individuals were assessed a second time (T2), and 125 a third time (T3). Depending on whether they maintained or worsened their profile, based on their initial performance, participants were then classified as resistant or declining. Results At baseline, all individuals showed education and occupation as the best predictors of performance, in addition to age. Furthermore, across assessments, the resistant had higher levels of education and occupation than the declining. In particular, the education and occupation predicted cognitive performance in all groups considered, from the subjective cognitive decline to the one with the most severely impaired participants. Conclusions This study highlights the role of working activity in protecting from cognitive decline across all fragile elderly groups and even more so the individuals who are at very high risk of decline.

Association between psychosocial and functional factors and language and verbal fluency performance in older adults

“…Education is associated with a lower risk of developing dementia and better cognitive functioning. For instance, Mondini et al ( 2022) 25 verified the contribution of age, sex, comorbidity, educational attainment, and occupation to provide cognitive reserve in a longitudinal study in older adults. Participants (n=3,081) were assessed at the beginning of the study with a battery of neuropsychological tests -those with unimpaired profiles were classified as subjective cognitive decline; those slightly impaired, as mild neurocognitive decline; and those severely impaired, as major neurocognitive decline.…”

Cognitive reserve estimated with a life experience questionnaire outperforms education in predicting performance on MoCA: Italian normative data

“…The importance of considering education together with other socio-demographic variables, proven to act as protective factors in longitudinal studies (Mondini et al, 2022;Ward et al, 2015), strongly suggests that normative data may improve when considering a composite proxy of CR in the calculation cut-off scores.…”

Global Examination of Mental State: An open tool for the brief evaluation of cognition

“…Another important point is that scores of screenings, as is the case for all cognitive tests, have so far only been adjusted for age, education, and sex (Strauss et al., 2006 ), although other variables may be at play and influence cognition (e.g., sociobehavioral or socioeconomic factors Fratiglioni et al., 2004 ; Livingston et al., 2017 ; Mondini et al., 2022 ; Ward et al., 2015 ). From this perspective, education is only one component of the concept of Cognitive Reserve (CR, Stern, 2003 ), which is well recognized as a comprehensive measure of abilities and knowledge acquired during life (Stern & Barulli, 2009 ), and as a modulator of cognitive performance (Lojo‐Seoane et al., 2018 ; Mitchell et al., 2012 ; Montemurro et al., 2019 ; Steffener & Stern, 2012 ).…”

“…From this perspective, education is only one component of the concept of Cognitive Reserve (CR, Stern, 2003 ), which is well recognized as a comprehensive measure of abilities and knowledge acquired during life (Stern & Barulli, 2009 ), and as a modulator of cognitive performance (Lojo‐Seoane et al., 2018 ; Mitchell et al., 2012 ; Montemurro et al., 2019 ; Steffener & Stern, 2012 ). CR is considered a protective factor against major neurocognitive decline (Mondini et al., 2022 ), whereas in other pathologies, CR shows a positive effect on recovery after brain damage (Hindle et al., 2014 ; Menardi et al., 2020 ; Nunnari et al., 2014 ). Thus, in order to have a clearer picture of the examinees’ performance, test scores should be better adjusted for CR rather than merely age and education.…”