Early-life cognitive enrichment may stave off dementia

  • Oveisgharan S & al.
  • JAMA Neurol
  • 29 Jun 2020

  • curated by Susan London
  • Clinical Essentials
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Takeaway

  • 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.”

Key results

  • 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.

Study design

  • 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.

Limitations

  • Cohort was predominantly female, white, well-educated.
  • Possible recall bias.
  • Limited power to assess association of cognitive enrichment with non-AD pathologic changes.