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ABSTRACT
Objective
To synthesize quantitatively the mild cognitive impairment (MCI) literature with respect to the relationship between cognitive reserve and neuropsychological and functional outcomes.
Method
Participants with a diagnosis of MCI (total n = 7,871; 53% female) were included in this random-effects meta-analysis. Neuropsychological measures were combined into composite scores (e.g., overall cognitive functioning, screening measures, memory, language, visuospatial, attention/processing speed/working memory, executive functioning, and motor functioning). Measures assessing real-world abilities were combined into an activities of daily living (ADL) composite.
Results
Nearly all neuropsychological composite values were significantly correlated with education, with effect sizes ranging from small to moderate. The effect between overall neuropsychological functioning and occupation was weak and varied by cognitive domain. For cognitively stimulating leisure activity, only overall neuropsychological functioning demonstrated a significant relationship, with a weak effect size (r = .16). In contrast, ADLs were most strongly associated with leisure experience (r = .27), with a negligible relationship with education (r = 0.08) and occupation (r = 0.09).
Conclusions
Of the cognitive reserve proxies examined in this study, participation in leisure activity had the largest magnitude of effect size with ADL functioning. This was in stark contrast to the negligible relationship found for education and occupation. Although education has been widely considered the most important cognitive reserve proxy with respect to cognition, this work questions whether other lifestyle factors may play a more important role in preserving real world functioning.
Acknowledgments
C.B. gratefully acknowledges funding support from a Canadian Graduate Scholarship (Doctoral) from the Canadian Institutes of Health Research (Fund # 503504).
These authors also gratefully thank and acknowledge the corresponding authors/groups who responded to our requests for additional data including authors from the ADRC Johns Hopkins, ADRC Mount Sinai Medical Center and the University of South Florida (Mendoza et al., Citation2020), Alzheimer Center Amsterdam/Vrije Universiteit Amsterdam, Cairo University, Chicago Health and Aging Project, Cognitive Complaints Cohort, Czech Brain Aging Study, The Education University of Hong Kong, Gait and Brain Study, Heidelberg University, Hellenic Longitudinal Investigation of Ageing and Diet study, Hospital Universitario Santa María del Rosell, Jikei University School of Medicine/Kashiwa Hospital, National University of Athens/University General Hospital, Mayo Clinic Study of Aging, Medical University Innsbruck, Motivational Reserve study in Alzheimer’s disease, Peruvian Institute of Neurosciences, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Sidney Kimmel Jefferson Medical College at Thomas Jefferson University, Sir Charles Gairdner Hospital, Sunnybrook Dementia Study, Sydney Memory and Ageing Study, Tan Tock Seng Hospital, Thammasat University, University of Alabama at Birmingham, University of Chichester, University of Genoa, University Kebangsaan Malaysia, University of Oklahoma Health Sciences Center, University of Munich, University of Santiago de Compostela, University of Sheffield, University of Studies of Bari, Warren Alpert Medical School/Brown University, and WHICAP. Additionally, data used in this meta-analysis were obtained from the Arizona Study of Aging and Neurodegenerative Disorders (AZSAND) database (www.brainandbodydonationprogram.org) on 5 February 2020 via a corresponding author.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Supplementary material
Supplemental data for this article can be accessed here