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

Article type: Research Article

Authors: Marioni, Riccardo E.a; * | van den Hout, Ardob | Valenzuela, Michael J.c; d; e | Brayne, Carola | Matthews, Fiona E.b | MRC Cognitive Function and Ageing Study

Affiliations: [a] Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK | [b] MRC Biostatistics Unit, Cambridge, UK | [c] School of Psychiatry, University of New South Wales, Sydney, Australia | [d] Brain and Ageing Research Program, Faculty of Medicine, University of New South Wales, Sydney, Australia | [e] Regenerative Neuroscience Group, Faculty of Medicine, University of New South Wales, Sydney, Australia

Correspondence: [*] Correspondence to: Riccardo E. Marioni, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 0SR, UK. Tel.: +44 (0)1223 763837; Fax: +44 (0)1223 330330; E-mail: [email protected].

Keywords: All epidemiology, cognitive aging, cognitive reserve, education

DOI: 10.3233/JAD-2011-110377

Journal: Journal of Alzheimer's Disease, vol. 28, no. 1, pp. 223-230, 2012

Accepted 28 August 2011
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Published: 12 January 2012
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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.

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