Role of cognitive reserve in progression from mild cognitive impairment to dementia

Allegri, Ricardo F.; Taragano, Fernando E.; Krupitzki, Hugo; Serrano, Cecilia M.; Dillon, Carol; Sarasola, Diego; Feldman, Mónica; Tufró, Graciela; Martelli, María; Sanchez, Viviana

doi:10.1590/S1980-57642010DN40100005

Abstract

Cognitive reserve is the ability to optimize performance through differential recruitment of brain networks, which may reflect the use of alternative cognitive strategies. Objectives: To identify factors related to cognitive reserve associated with progression from mild cognitive impairment (MCI) to degenerative dementia. Methods: A cohort of 239 subjects with MCI (age: 72.2±8.1 years, 58% women, education: 12 years) was assessed and followed for five years (2001 to 2006). Results: In the first year, 13.7% of MCI converted to dementia and 34.7% converted within three years (78.3% converted to Alzheimer's dementia). Risk factors for those who converted were education less than 12 years, MMSE score less than 27, Boston naming test score less than 51, IQ (Intelligence Quotient) less than 111, age over 75 years, lack of occupation at retirement, and presence of intrusions in memory recall (all account for 56% of the variability of conversion). Conclusions: MCI patients are a population at high risk for dementia. The study of risk factors (e.g. IQ, education and occupation), particularly those related to cognitive reserve, can contribute important evidence to guide the decision-making process in routine clinical activity and public health policy.

Key words:
mild cognitive impairment; risk factors; dementia; cognitive reserve

Resumo

Reserva cognitiva é a habilidade em otimizar o desempenho através do recrutamento de redes neurais, que talvez reflitam o uso de estratégias cognitivas alternativas. Objetivos: Identificar fatores relacionados à reserva cognitiva associados à progressão do comprometimento cognitivo leve (CCL) para demência degenerativa. Métodos: Uma coorte de 239 indivíduos com CCL (idade: 72.2±8.1 anos, 58% mulheres, educação: 12 anos) foram avaliados e seguidos por cinco anos (2001-2006). Resultados: No primeiro ano 13.7% dos CCL converteram para demência e 34.7% em três anos (78.3% converteram para doença de Alzheimer). Os fatores de risco para aqueles que converteram foram: educação menor do que 12 anos, MMSE menor do que 27, teste de Nomeação de Boston menor do que 51, QI (Quociente de Inteligência) menor do que 111, idade superior a 75 anos, falta de ocupação na aposentadoria, e presença de intrusões na memória de evocação (todos contando para 56% da variabilidade de conversão). Conclusões: Pacientes com CCL são uma população de risco para demência. O estudo dos fatores de risco (como QI, educação e ocupação), principalmente, aqueles relacionados à reserva cognitiva podem contribuir para uma evidência importante para o processo de decisões na atividade clínica e na saúde pública.

Palavras-chave:
comprometimento cognitivo leve; fatores de risco; demência; reserva cognitiva

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References

¹
Stern Y. The cognitive reserve? Theory and research application of the reserve concept. J Int Neuropsychol Soc 2002;8:44-460.
²
Stern Y, Gurland B, Tatemichi TK, Tang MX, Wilder D, Mayeux R. Influence of education and occupation on the incidence of Alzheimer's disease. J Am Med Assoc 1994;271:1004-1010.
³
Alexander GE, Furey ML, Grady CL, et al. Association of premorbid intellectual function with cerebral metabolism in Alzheimer's disease: implications for the cognitive reserve hypothesis. Am J Psychiatry 1997;154:165-172.
⁴
Wilson RS, Bennett DA, Gilley DW, Beckett LA, Barnes LL, Evans DA. Premorbid reading activity and patterns of cognitive decline in Alzheimer disease. Arch Neurol 2000;57:1718-1723.
⁵
Scarmeas N, Levy G, Tang MX, Manly J, Stern Y. Influence of leisure activity on the incidence of Alzheimer's disease. Neurology 2001;57:2236-2242.
⁶
Manly JJ, Touradji P, Tang M-X, Stern Y. Literacy and memory decline among ethnically diverse elders. J Clin Exp Neuropsychol 2003;5:680-690.
⁷
Baldivia B, Andrade VM, Amoedo bueno OF. Contribution of education, occupation and cognitively stimulating activities to the formation of cognitive reserve. Dement Neuropsychol 2008;2:173-182.
⁸
Stern Y, Habeck C, Moeller J, et al. Brain Networks associated with cognitive reserve in healthy young and old adults. Cerebr cortex 2005;15:394-402.
⁹
Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kolmen E. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol 1999;56:303-308.
¹⁰
Winblad B, Palmer K, Kipivelto M, et al. Mild Cognitive Impairment: beyond controversies, towards a consensus-report of the international Working Group on Mild Cognitive Impairment. J Intern Med 2004;256:240-246.
¹¹
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:53-63.
¹²
Folstein MF, Folstein SE, McHugh PR. "Mini mental state" a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.
¹³
Allegri RF, Ollari JA, Mangone CA, et al. El "Mini Mental State Examination" en la Argentina: Instrucciones para su administración. Rev Neurol Argentina, 1999;24:31-35.
¹⁴
Butman J, Arizaga RL, Harris P, et al. El "Mini Mental State Examination" en Español. Normas para Buenos Aires. Rev Neurol Argentina 2001;261:11-15.
¹⁵
Signoret JL, Whiteley A. Memory battery scale. Intern Neuropsych Soc Bull 1979; 9:2-26.
¹⁶
Kaplan EF, Goodglass H, Weintraub S. The Boston Naming Test (2nd ed.). Philadelphia: Lea & Febiger; 1993.
¹⁷
Allegri RF, Mangone CA, Rymberg S, Fernandez A, Taragano FE. Spanish version of the Boston naming Test in Buenos Aires. Clin Neuropsychol, 1997;11:416-420.
¹⁸
Benton AL. Differential behavioral effects in frontal lobe disease. Neuropsychologia 1968;5:53-60.
¹⁹
Reitan RM. Validity of the Trail Making Test as an indication of organic brain damage. Percept Mot Skills 1958;8:271.
²⁰
Wechsler Abbreviated Scale of Intelligence (WASI) The Psychological Corporation, USA; 1999.
²¹
American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders, DSM-IV, Washington, DC; 1994.
²²
Mc Khann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS ADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer's disease. Neurology 1984;34:939-944.
²³
Hachinski VC, Lassen NA, Marshall J. Multi-infarct dementia: a cause of mental deterioration in the elderly. Lancet 1974; 2(7874):207-10.
²⁴
Kral VC. Senescent forgetfulness: Benign and malignant. Can Med Assoc J 1962;86:257-260.
²⁵
Crook T, Bartus RT, Ferris SH, Withehouse P, Cohen GD, Gershon S. Age associated memory impairment: proposed diagnostic criteria and measures of clinical change. Report of a National Institute of Mental Health work group. Dev Neuropsychol 1986;2:261-276.
²⁶
Blackford RC, La Rue A. Criteria for diagnosis AAMI: proposed improvement from the field. Dev Neuropsychol 1989;5: 295-306.
²⁷
Levy R. Ageing-associated decline. Psychogeriatrics 1994;6:63-68.
²⁸
Allegri RF, Glaser FB, Taragano FE, Buschke H. Mild cognitive impairment: Believe it or not? Int Rev Psychiatry, 2008;20: 357-363.
²⁹
Flicker C, Ferris SH, Reisberg B. Mild cognitive impairment in the elderly predictors of dementia. Neurology 1991;41:1006-1009.
³⁰
Harris P, Drake M, Allegri RF. Deterioro cognitivo leve: en búsqueda de la predemecia. Acta Psiquiátr Psicol Am Lat 2001;47:11-20.
³¹
Dubois B, Albert ML. Amnestic MCI or prodromal Alzheimer's disease? Lancet Neurol 2004;3:246-248.
³²
Allegri RF, Drake M, Harris P, Serrano CM, Taragano FE. Intrusions in Verbal Learning in Mild Cognitive Impairment: Prodromal Alzheimer's Disease?. Neurology 2005;65(Suppl 1):A-165.
³³
Dubois B, Feldman H, Jacova C, et al. Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDS-ADRDA criteria. Lancet Neurol 2007;6:734-746.
³⁴
Whalley LJ, Deary IJ, Appletoin CL, Starr JM, Cognitive Reserve and the neurobiology of cognitive aging. Ageing Res Rev 2004;3:369-382.
³⁵
Kryscio RJ, Schmitt FA, Salazar JC, Mendiondo MS, Markesbery WR . Risk factors for transitions from normal to mild cognitive impairment and dementia. Neurology 2006;66:828-832.
³⁶
Zhang MY, Katzman R, Salmon D, et al. The prevalence of dementia and Alzheimer's disease in Shanghai, China: impact of age, gender and education. Ann Neurol 1990;27:428-437.
³⁷
Katzman R. Education and the prevalence of dementia an Alzheimer's disease. Neurology 1993;43:13-20.
³⁸
Ritchie, K., Artero, S. and Touchon, J. Classification criteria for mild cognitive impairment A population-based validation study. Neurology 2001;56:37-42
³⁹
Arizaga RL, Harris P y Allegri RF. Epidemiología de las Demencias. JC Arango Lasprilla, S Fernández Guinea, A Ardila (Editores). En "Las Demencias: Aspectos Clínicos, Neuropsicológicos y Tratamiento". México: Editorial El Manual Moderno; 2003.

Publication Dates

Publication in this collection
Jan-Mar 2010

History

Received
29 Sept 2009
Accepted
03 Feb 2010

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Stern Y. The cognitive reserve? Theory and research application of the reserve concept. J Int Neuropsychol Soc 2002;8:44-460.

[2] ²
Stern Y, Gurland B, Tatemichi TK, Tang MX, Wilder D, Mayeux R. Influence of education and occupation on the incidence of Alzheimer's disease. J Am Med Assoc 1994;271:1004-1010.

[3] ³
Alexander GE, Furey ML, Grady CL, et al. Association of premorbid intellectual function with cerebral metabolism in Alzheimer's disease: implications for the cognitive reserve hypothesis. Am J Psychiatry 1997;154:165-172.

[4] ⁴
Wilson RS, Bennett DA, Gilley DW, Beckett LA, Barnes LL, Evans DA. Premorbid reading activity and patterns of cognitive decline in Alzheimer disease. Arch Neurol 2000;57:1718-1723.

[5] ⁵
Scarmeas N, Levy G, Tang MX, Manly J, Stern Y. Influence of leisure activity on the incidence of Alzheimer's disease. Neurology 2001;57:2236-2242.

[6] ⁶
Manly JJ, Touradji P, Tang M-X, Stern Y. Literacy and memory decline among ethnically diverse elders. J Clin Exp Neuropsychol 2003;5:680-690.

[7] ⁷
Baldivia B, Andrade VM, Amoedo bueno OF. Contribution of education, occupation and cognitively stimulating activities to the formation of cognitive reserve. Dement Neuropsychol 2008;2:173-182.

[8] ⁸
Stern Y, Habeck C, Moeller J, et al. Brain Networks associated with cognitive reserve in healthy young and old adults. Cerebr cortex 2005;15:394-402.

[9] ⁹
Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kolmen E. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol 1999;56:303-308.

[10] ¹⁰
Winblad B, Palmer K, Kipivelto M, et al. Mild Cognitive Impairment: beyond controversies, towards a consensus-report of the international Working Group on Mild Cognitive Impairment. J Intern Med 2004;256:240-246.

[11] ¹¹
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:53-63.

[12] ¹²
Folstein MF, Folstein SE, McHugh PR. "Mini mental state" a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.

[13] ¹³
Allegri RF, Ollari JA, Mangone CA, et al. El "Mini Mental State Examination" en la Argentina: Instrucciones para su administración. Rev Neurol Argentina, 1999;24:31-35.

[14] ¹⁴
Butman J, Arizaga RL, Harris P, et al. El "Mini Mental State Examination" en Español. Normas para Buenos Aires. Rev Neurol Argentina 2001;261:11-15.

[15] ¹⁵
Signoret JL, Whiteley A. Memory battery scale. Intern Neuropsych Soc Bull 1979; 9:2-26.

[16] ¹⁶
Kaplan EF, Goodglass H, Weintraub S. The Boston Naming Test (2nd ed.). Philadelphia: Lea & Febiger; 1993.

[17] ¹⁷
Allegri RF, Mangone CA, Rymberg S, Fernandez A, Taragano FE. Spanish version of the Boston naming Test in Buenos Aires. Clin Neuropsychol, 1997;11:416-420.

[18] ¹⁸
Benton AL. Differential behavioral effects in frontal lobe disease. Neuropsychologia 1968;5:53-60.

[19] ¹⁹
Reitan RM. Validity of the Trail Making Test as an indication of organic brain damage. Percept Mot Skills 1958;8:271.

[20] ²⁰
Wechsler Abbreviated Scale of Intelligence (WASI) The Psychological Corporation, USA; 1999.

[21] ²¹
American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders, DSM-IV, Washington, DC; 1994.

[22] ²²
Mc Khann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS ADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer's disease. Neurology 1984;34:939-944.

[23] ²³
Hachinski VC, Lassen NA, Marshall J. Multi-infarct dementia: a cause of mental deterioration in the elderly. Lancet 1974; 2(7874):207-10.

[24] ²⁴
Kral VC. Senescent forgetfulness: Benign and malignant. Can Med Assoc J 1962;86:257-260.

[25] ²⁵
Crook T, Bartus RT, Ferris SH, Withehouse P, Cohen GD, Gershon S. Age associated memory impairment: proposed diagnostic criteria and measures of clinical change. Report of a National Institute of Mental Health work group. Dev Neuropsychol 1986;2:261-276.

[26] ²⁶
Blackford RC, La Rue A. Criteria for diagnosis AAMI: proposed improvement from the field. Dev Neuropsychol 1989;5: 295-306.

[27] ²⁷
Levy R. Ageing-associated decline. Psychogeriatrics 1994;6:63-68.

[28] ²⁸
Allegri RF, Glaser FB, Taragano FE, Buschke H. Mild cognitive impairment: Believe it or not? Int Rev Psychiatry, 2008;20: 357-363.

[29] ²⁹
Flicker C, Ferris SH, Reisberg B. Mild cognitive impairment in the elderly predictors of dementia. Neurology 1991;41:1006-1009.

[30] ³⁰
Harris P, Drake M, Allegri RF. Deterioro cognitivo leve: en búsqueda de la predemecia. Acta Psiquiátr Psicol Am Lat 2001;47:11-20.

[31] ³¹
Dubois B, Albert ML. Amnestic MCI or prodromal Alzheimer's disease? Lancet Neurol 2004;3:246-248.

[32] ³²
Allegri RF, Drake M, Harris P, Serrano CM, Taragano FE. Intrusions in Verbal Learning in Mild Cognitive Impairment: Prodromal Alzheimer's Disease?. Neurology 2005;65(Suppl 1):A-165.

[33] ³³
Dubois B, Feldman H, Jacova C, et al. Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDS-ADRDA criteria. Lancet Neurol 2007;6:734-746.

[34] ³⁴
Whalley LJ, Deary IJ, Appletoin CL, Starr JM, Cognitive Reserve and the neurobiology of cognitive aging. Ageing Res Rev 2004;3:369-382.

[35] ³⁵
Kryscio RJ, Schmitt FA, Salazar JC, Mendiondo MS, Markesbery WR . Risk factors for transitions from normal to mild cognitive impairment and dementia. Neurology 2006;66:828-832.

[36] ³⁶
Zhang MY, Katzman R, Salmon D, et al. The prevalence of dementia and Alzheimer's disease in Shanghai, China: impact of age, gender and education. Ann Neurol 1990;27:428-437.

[37] ³⁷
Katzman R. Education and the prevalence of dementia an Alzheimer's disease. Neurology 1993;43:13-20.

[38] ³⁸
Ritchie, K., Artero, S. and Touchon, J. Classification criteria for mild cognitive impairment A population-based validation study. Neurology 2001;56:37-42

[39] ³⁹
Arizaga RL, Harris P y Allegri RF. Epidemiología de las Demencias. JC Arango Lasprilla, S Fernández Guinea, A Ardila (Editores). En "Las Demencias: Aspectos Clínicos, Neuropsicológicos y Tratamiento". México: Editorial El Manual Moderno; 2003.

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