Association of cognitive reserve with transitions across cognitive states and death in older adults: A 15-year follow-up study

INTRODUCTIONWe investigated the association of cognitive reserve (CR) with transitions across cognitive states and death.METHODSThis population-based cohort study included 2631 participants (age >= 60 years) who were dementia-free at baseline and regularly examined up to 15 years. Data were analyzed using the Markov multistate models.RESULTSEach 1-point increase in the composite CR score (range: -4.25 to 3.46) was significantly associated with lower risks of transition from normal cognition to cognitive impairment, no dementia (CIND) (multivariable-adjusted hazards ratio = 0.78; 95% confidence interval = 0.72-0.85) and death (0.85; 0.79-0.93), and from CIND to death (0.82; 0.73-0.91), but not from CIND to normal cognition or dementia. A greater composite CR score was associated with a lower risk of transition from CIND to death in people aged 60-72 but not in those aged >= 78 years.DISCUSSIONCR contributes to cognitive health by delaying cognitive deterioration in the prodromal phase of dementia.Highlights We use Markov multistate model to examine the association between cognitive reserve and transitions across cognitive states and death. A great cognitive reserve contributes to cognitive health by delaying cognitive deterioration in the prodromal phase of dementia. A great cognitive reserve is associated with a lower risk of transition from cognitive impairment, no dementia to death in people at the early stage of old age, but not in those at the late stage of old age.