Cognitive functioning, cognitive reserve, and residential care placement in patients with Alzheimer's and related dementias

ABSTRACT

Objective: To test the hypothesis that patients with mild to moderate dementia with higher initial cognitive reserve (higher education levels exhibit faster cognitive decline at later stages of disease progression as they approach residential care (RC) placement.

Method: Two provincial administrative databases were used. One contained individuals' scores of cognitive functioning (assessed at 6- to 12-month intervals using the Standardized Mini-Mental State Examination, SMMSE, 2007–2014) and education level; the second (BC Ministry of Health Home and Community Care database, 2001–2014) contained individuals' RC placement; N = 10531.

Results: During 2.5–0.5 years prior to placement, SMMSE scores of patients with 0–8 years of education dropped slightly (M D 20.6 to 20.0), while patients with 9–12 years and 13+ years of education started higher (M D 21.8 and 21.4), but decreased faster and ended up lower (M D 19.5 and 18.8). Six-months prior to placement, SMMSE scores of all groups dropped almost 2 points.

Conclusions: Once cognitive reserve of more highly educated dementia patients is depleted and they approach RC placement, their cognitive functioning deteriorates faster. Finding effective interventions that maintain or enhance cognitive reserve may increase the time in the community for dementia patients.

KEYWORDS:

• Cognitive reserve
• residential care
• Alzheimer's disease and related dementias
• Alzheimer's disease

Acknowledgments

This work was supported by the Pharmaceutical Services Division, Ministry of Health, Provincial Government of British Columbia, under Grant 00816, as part of the Alzheimer's Drug Therapy Initiative (ADTI) for purpose of developing evidence for the use of ChEI treatment in the community.

Disclosure statement

All references, opinions, and conclusions drawn in this publication are those of the ADTI researchers, and do not reflect the opinions or policies of the BC Ministry of Health.

Authors have no financial interests or benefits arising from the direct application of this research.

Additional information

Funding

Pharmaceutical Services Division, Ministry of Health, Provincial Government of British Columbia [grant number 00816].