Cardiovascular Research

Cognitive reserve is associated with education, social determinants, and cognitive outcomes among older American Indians in the

Authors: Astrid M Suchy-Dicey|||W T Longstreth|||Dedra S Buchwald|||Kristoffer Rhoads|||Thomas J Grabowski

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Abstract

Cognitive reserve, a component of resilience, may be conceptualized as the ability to overcome accumulating neuropathology and maintain healthy aging and function. However, research measuring and evaluating it in American Indians is needed. We recruited American Indians from 3 regional centers for longitudinal examinations (2010-13, n = 818; 2017-19, n = 403) including MRI, cognitive, clinical, and questionnaire data. We defined cognitive reserve by measuring the residual from individual regressions of cognitive tests over imaged brain volumes, adjusted for age and sex. Analyses examined three different metrics of cognitive reserve against sociodemographic, clinical, and longitudinal cognitive data in causal mediation models. Better cognitive reserve was significantly associated with more education, higher income, lower prevalence of depression, lower prevalence of diabetes, and lower prevalence of kidney disease, but we found no statistically significant evidence for an association with plasma biomarkers for Alzheimer's disease and related dementias, APOE e4 carrier status, alcohol use, body mass, or hypertension. Better cognitive reserve was associated with better cognitive function over mean 6.7 years follow-up (range 4-9 years); and the association for education with cognition over time was mediated in part (15-24%) by cognitive reserve. Cognitive reserve, although challenging to measure, appears important for understanding the range of cognitive aging in American Indians.

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Reference List

Stern, Y. et al. A framework for concepts of reserve and resilience in aging. Neurobiol. Aging124, 100–103 (2023).|||Stern, Y., Barnes, C. A., Grady, C., Jones, R. N. & Raz, N. Brain reserve, cognitive reserve, compensation, and maintenance: operationalization, validity, and mechanisms of cognitive resilience. Neurobiol. Aging83, 124–129 (2019).|||Joshi, M. S. & Galvin, J. E. Cognitive resilience in brain health and dementia research. J. Alzheimers Dis.90, 461–473 (2022).|||Franzmeier, N. et al. Left frontal cortex connectivity underlies cognitive reserve in prodromal Alzheimer disease. Neurology88, 1054–1061 (2017).|||Zahodne, L. B., Stern, Y. & Manly, J. J. Differing effects of education on cognitive decline in diverse elders with low versus high educational attainment. Neuropsychology29, 649–657 (2015).|||Stern, Y. Cognitive reserve. Neuropsychologia47, 2015–2028 (2009).|||Valenzuela, M. J. & Sachdev, P. Brain reserve and dementia: a systematic review. Psychol. Med.36, 441–454 (2006).|||Verney, S. P. et al. The associations among sociocultural factors and neuropsychological functioning in older American Indians: the Strong Heart Study. Neuropsychology10.1037/neu0000574 (2019).|||Jones, R. N. et al. Conceptual and measurement challenges in research on cognitive reserve. J. Int. Neuropsychol. Soc.17, 593–601 (2011).|||Yao, T., Sweeney, E., Nagorski, J., Shulman, J. M. & Allen, G. I. Quantifying cognitive resilience in Alzheimer’s Disease: the Alzheimer’s disease cognitive resilience score. PLoS ONE15, e0241707 (2020).|||Guo, W. & Shi, J. White matter hyperintensities volume and cognition: a meta-analysis. Front. Aging Neurosci.14, 949763 (2022).|||Nelson, P. T. & Jicha, G. A. Early hippocampal atrophy is an important signal for clinicians but not necessarily a harbinger of Alzheimer disease. Neurology101, 1087–1088 (2023).|||Kelley, A. & Small, C. Establishing the reliability and validity of the sources of strength in one American Indian community. Am. Indian Alsk Native Ment. Health Res.23, 84–92 (2016).|||Kahn, C. B. et al. American Indian Elders’ resilience: sources of strength for building a healthy future for youth. Am. Indian Alsk. Native Ment. Health Res.23, 117–133 (2016).|||Ore, C. E., Teufel-Shone, N. I. & Chico-Jarillo, T. M. American Indian and Alaska native resilience along the life course and across generations: a literature review. Am. Indian Alsk. Native Ment. Health Res.23, 134–157 (2016).|||Nikolaus, C. J., Sinclair, K., Buchwald, D. & Suchy-Dicey, A. M. Association of stress and resilience with cardiometabolic health among American Indian and Alaska Native adults. Prev. Med. Rep.24, 101517 (2021).|||Suchy-Dicey, A. et al. Psychological and social support associations with mortality and cardiovascular disease in middle-aged American Indians: the Strong Heart Study. Soc. Psychiatry Psychiatr. Epidemiol.57, 1421–1433 (2022).|||Suchy-Dicey, A. M. et al. Epidemiology and prevalence of dementia and Alzheimer’s disease in American Indians: data from the Strong Heart Study. Alzheimers Dement.20, 4174–4184 (2024).|||Suchy-Dicey, A. M. et al. Plasma biomarkers of Alzheimer’s disease and related dementias in American Indians: the strong Heart Study. Alzheimers Dement.20, 2072–2079 (2024).|||Suchy-Dicey, A., Howard, B., Longstreth, W. T. Jr., Reiman, E. M. & Buchwald, D. APOE genotype, hippocampus, and cognitive markers of Alzheimer’s disease in American Indians: data from the Strong Heart Study. Alzheimers Dement.18, 2518–2526 (2022).|||Shibata, D. et al. Vascular risk factors and findings on brain MRI of elderly adult American Indians: the strong Heart Study. Neuroepidemiology52, 173–180 (2019).|||Cholerton, B. et al. Type 2 diabetes and later cognitive function in older American Indians: the Strong Heart Study. Int. J. Geriatr. Psychiatry34, 1050–1057 (2019).|||Suchy-Dicey, A., Su, Y., Buchwald, D. S., Manson, S. M. & Reiman, E. M. Volume atrophy in medial temporal cortex and verbal memory scores in American Indians: data from the Strong Heart Study. Alzheimers Dement.10.1002/alz.12889 (2022).|||Suchy-Dicey, A. et al. Cognitive correlates of MRI-defined cerebral vascular injury and atrophy in elderly American Indians: the strong Heart Study. J. Int. Neuropsychol. Soc.26, 263–275 (2020).|||Lee, E. T. et al. The strong Heart Study. a study of cardiovascular disease in American Indians: design and methods. Am. J. Epidemiol.132, 1141–1155 (1990).|||Suchy-Dicey, A. M. et al. Educational and clinical associations with longitudinal cognitive function and brain imaging in American Indians: the Strong Heart Study. Neurology99, e2637–e2647 (2022).|||Wechsler, D. Wechsler Adult Intelligence Scale—Fourth Edition Administration and Scoring Manual. (Pearson, San Antonio, TX, 2008a).|||Benton, A. L. & Hansher, K. Multilingual Aphasia Examination 2nd edn. (AJA Associates, 1976).|||Delis, D. C., Kramer, J. H., Kaplan, E. & Ober, B. A. California Verbal Learning Test (CVLT-II) 2nd edn. (The Psychological Corporation, 2000).|||Teng, E. L. & Chang Chui, H. The modified mini-mental (3MS) examination. J. Clin. Psychiatry48, 314–318 (1987).|||Morris, J. C. et al. The uniform data set (UDS): clinical and cognitive variables and descriptive data from Alzheimer Disease Centers. Alzheimer Dis. Assoc. Disord.20, 210–216 (2006).|||Nasreddine, Z. S. et al. The Montreal Cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J. Am. Geriatr. Soc.53, 695–699 (2005).|||Possin, K. L., Laluz, V. R., Alcantar, O. Z., Miller, B. L. & Kramer, J. H. Distinct neuroanatomical substrates and cognitive mechanisms of figure copy performance in Alzheimer’s disease and behavioral variant frontotemporal dementia. Neuropsychologia49, 43–48 (2011).|||Liew, T. M. Developing a brief neuropsychological battery for early diagnosis of cognitive impairment. J. Am. Med. Dir. Assoc.20, 1054.e1011–1054.e1020 (2019).|||Llinas-Regla, J. et al. The trail making test. Assessment24, 183–196 (2017).|||Ivanova, I., Salmon, D. P. & Gollan, T. H. The multilingual naming test in Alzheimer’s disease: clues to the origin of naming impairments. J. Int. Neuropsychol. Soc.19, 272–283 (2013).|||Suchy-Dicey, A. M. et al. Psychometric reliability, validity, and generalizability of 3MSE scores among American Indian adults: the Strong Heart Study. J. Int. Neuropsychol. Soc.30, 454–463 (2024).|||Suchy-Dicey, A. M. et al. Psychometric properties of controlled oral word association (COWA) test and associations with education and bilingualism in American Indian adults: the Strong Heart Study. Assessment31, 745–757 (2024).|||Suchy-Dicey, A. M. et al. Psychometric reliability, validity, and generalizability of MoCA in American Indian adults: the Strong Heart Study. Assessment10.1177/10731911241261436 (2024).|||Lovden, M., Backman, L., Lindenberger, U., Schaefer, S. & Schmiedek, F. A theoretical framework for the study of adult cognitive plasticity. Psychol. Bull.136, 659–676 (2010).|||2024 Alzheimer’s disease facts and figures. Alzheimers Dement. 20, 3708–3821 (2024).|||Johnson, N. F., Kim, C. & Gold, B. T. Socioeconomic status is positively correlated with frontal white matter integrity in aging. Age35, 2045–2056 (2013).|||McEwen, B. S. The brain on stress: toward an integrative approach to brain, body, and behavior. Perspect. Psychol. Sci.8, 673–675 (2013).|||Suchy-Dicey, A. et al. Depression symptoms and cognitive test performance in older American indians: the Strong Heart Study. J. Am. Geriatr. Soc.68, 1739–1747 (2020).|||Suchy-Dicey, A. M. et al. Findings of vascular brain injury and structural loss from cranial magnetic resonance imaging in elderly American Indians: the Strong Heart Study. Neuroepidemiology48, 39–47 (2017).