- Older adults with a more cognitively enriched early life have a slower pace of cognitive decline and a lower global measure of Alzheimer disease (AD) brain pathology at death.
Why this matters
- Editorial notes that a better understanding of "cognitive reserve, resistance, and resilience" may allow for trials that focus on "enhancing protection rather than simply reducing disease.”
- Participants with higher composite measures of early-life cognitive enrichment had:
- Lower adjusted global AD pathology score (estimate, −0.057; P=.01).
- Slower cognitive decline (mean, −0.13 [range, −1.74 to 0.85] units per year).
- Each 1-unit increase conferred a 25% slower rate of decline.
- Association between early-life cognitive enrichment and rate of late-life cognitive decline:
- 80% direct effect.
- 20% indirect effect through AD pathologic changes.
- A community-based cohort study (Rush Memory and Aging Project) of postmortem data for 813 adults (death after mean 7.0-year follow-up, at a mean age of 90.1 years).
- Self-reported indicators of early-life cognitive enrichment:
- Early-life socioeconomic status.
- Availability of cognitive resources at 12 years of age.
- Frequency of participation in cognitively stimulating activities.
- Early-life foreign language instruction.
- Main outcome: global AD pathology score (count of diffuse plaques, neuritic plaques, neurofibrillary tangles).
- Funding: National Institute on Aging.
- Cohort was predominantly female, white, well-educated.
- Possible recall bias.
- Limited power to assess association of cognitive enrichment with non-AD pathologic changes.