Is a higher level of early-life cognitive enrichment associated with lower levels of late-life Alzheimer disease and other common dementia-related pathological changes?
In this cohort study of 813 patients with postmortem data, a higher level of early-life cognitive enrichment was associated with a decreased Alzheimer disease pathology score but was not associated with any other dementia-related pathological changes.
Early-life cognitive enrichment was associated with late-life cognitive health in part through an association with fewer Alzheimer disease-related pathological changes.
Indicators of early-life cognitive enrichment (ELCE) have been associated with slower cognitive decline and decreased dementia in late life. However, the mechanisms underlying this association have not been elucidated.
To examine the association of ELCE with late-life Alzheimer disease (AD) and other common dementia-related pathological changes.
Design, Setting, and Participants
This clinical-pathological community-based cohort study, the Rush Memory and Aging Project, followed up participants before death for a mean (SD) of 7.0 (3.8) years with annual cognitive and clinical assessments. From January 1, 1997, through June 30, 2019, 2044 participants enrolled, of whom 1018 died. Postmortem data were leveraged from 813 participants. Data were analyzed from April 12, 2019, to February 20, 2020.
Four indicators of ELCE (early-life socioeconomic status, availability of cognitive resources at 12 years of age, frequency of participation in cognitively stimulating activities, and early-life foreign language instruction) were obtained by self-report at the study baseline, from which a composite measure of ELCE was derived.
Main Outcomes and Measures
A continuous global AD pathology score derived from counts of diffuse plaques, neuritic plaques, and neurofibrillary tangles.
The 813 participants included in the analysis had a mean (SD) age of 90.1 (6.3) years at the time of death, and 562 (69%) were women. In a linear regression model controlled for age at death, sex, and educational level, a higher level of ELCE was associated with a lower global AD pathology score (estimate, −0.057; standard error, 0.022; P = .01). However, ELCE was not associated with any other dementia-related pathological changes. In addition, a higher level of ELCE was associated with less cognitive decline (mean [SD], −0.13 [0.19] units per year; range, −1.74 to 0.85). An indirect effect through AD pathological changes constituted 20% of the association between ELCE and the rate of late-life cognitive decline, and 80% was a direct association.
Conclusions and Relevance
These findings suggest that ELCE was associated with better late-life cognitive health, in part through an association with fewer AD pathological changes.
Identify all potential conflicts of interest that might be relevant to your comment.
Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
Err on the side of full disclosure.
If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.
Not all submitted comments are published. Please see our commenting policy for details.
Oveisgharan S, Wilson RS, Yu L, Schneider JA, Bennett DA. Association of Early-Life Cognitive Enrichment With Alzheimer Disease Pathological Changes and Cognitive Decline. JAMA Neurol. Published online June 29, 2020. doi:10.1001/jamaneurol.2020.1941
Coronavirus Resource Center
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: