Validity and reliability of the Brazilian version of the Cognitive Reserve Assessment Scale in Health

Objective: As the older population increases, it is important to identify factors that may reduce the risks of dementia in the general population. One such factor is the concept of cognitive reserve (CR). The present study analyzed the psychometric properties of the Cognitive Reserve Assessment Scale in Health (CRASH) in the Brazilian population. This scale was originally developed to measure CR in individuals with severe mental illness. We also investigated the relationship between the CRASH and clinical or sociodemographic variables. Methods: This study was conducted with 398 individuals. We assessed sociodemographic variables and depression, anxiety, and stress symptoms (Depression, Anxiety and Stress Scale [DASS-21]) using a web-based survey. We constructed a confirmatory factor analysis (CFA) model in order to test the goodness of fit of the factor structure proposed in the original CRASH study. Results: The McDonald's hierarchical ω for CRASH using CFA parameters was 0.61, and the Cronbach's alpha coefficient indicated good internal consistency when considering all items (alpha = 0.7). Conclusions: Our results suggest that CRASH can be used to assess CR in the general population in Brazil.

Adaptación argentina del Cuestionario de Reserva Cognitiva: CRC-a / Argentinian adaptation of the Cognitive Reserve Questionnaire: CRQ-a

Resumen La reserva cognitiva (RC) se refiere al nivel de adaptabilidad de la cognición frente a cambios cerebrales. Varios estudios la han considerado un factor de protección de la enfermedad de Alzheimer (EA). En la región argentina no se cuenta con un instrumento validado que permita medir este constructo. El objetivo del presente trabajo es adaptar el Cuestionario de Reserva Cognitiva (CRC) a la población argentina, establecer puntajes de corte para determinar desde niveles bajos a superiores de RC y analizar qué variables predicen el puntaje total de la reserva. Las modificaciones introducidas a la adaptación fueron evaluadas a través de un proceso de juicio de expertos. Un total de 177 sujetos sanos completaron el Cuestionario de Reserva Cognitiva en su adaptación argentina (CRC-a). Mediante la medida de cuartiles, se establecieron puntajes de corte para determinar niveles bajos, medios, altos y superiores de la reserva. Se realizó una regresión lineal para evaluar si el sexo, la edad y la escolaridad predicen el nivel de RC. En la adaptación argentina del CRC se modificaron 3 de las 8 dimensiones totales y 16 de los 33 ítems totales con respecto al cuestionario original. La media del puntaje total obtenido por la muestra a partir del cuestionario fue de 15.06 con DS = 3.42. Puntajes menores a 13 reflejaron niveles bajos de RC, puntajes entre 13 y 16, niveles medios, puntajes entre 16 y 20, niveles altos, y puntajes superiores a 20, niveles superiores. La escolaridad resultó ser la única variable de predicción del nivel de RC. Si bien se encontraron diferencias entre grupos respecto a la variable sexo, esta no demostró ser predictiva. El CRC-a es el primer instrumento desarrollado en esta región para medir el nivel de RC. Contar con su validación abriría futuras líneas de investigaciones sobre posibles intervenciones para la prevención de enfermedades, tales como la EA.

Abstract Cognitive reserve (CR) refers to the level of adaptability of cognition after brain changes. It is based on processes that allow the activation of new synaptic connections after neurodegeneration, which permits to better withstand the consequences. This reserve is constituted by the interaction of innate individual characteristics (intrauterine or genetically determined) and the exposure to different life experiences. It begins its development in early stages of life and continues its transformation up to advances ages. The sociodemographic variables reported as the main ones to build the reserve are education, leisure activities, lifestyle, socioeconomic level and intelligence. Several studies have considered it as a protective factor for Alzheimer's Disease (AD). Subjects with high levels of CR have lower prevalence and incidence of AD in comparison to those with low levels of reserve. CR would lead to a late onset of symptoms, despite not having any effect on the underlying pathophysiological process of the disease. The reserve would not prevent AD from developing, but it would compensate the symptoms and, therefore, delay their onset. In some cases, there is such compensation that the symptoms do not manifest. There is no validated instrument available for the Argentinian region that allows to measure this construct. The aim of this study is to adapt the Cognitive Reserve Questionnaire to the Argentinian population, to establish cut-off scores to distinguish between low, medium, high and superior levels of CR and analyze which variables could predict the total reserve score. The modifications introduced in the adaptation were evaluated through an expert judgment process. A total of 177 healthy subjects completed the Cognitive Reserve Questionnaire in its Argentinian adaptation (CRQ-a). Through the measure of quartiles, cut-off scores were established to determine low, medium, high and superior levels of the reserve. A lineal regression was made to evaluate if age, education, and sex might predict the level of CR. Three of the eight total dimensions and 16 of the 33 total items that make up the original questionnaire were modified. The mean of the total score obtained by the sample from the questionnaire was 15.06 with SD = 3.42. Scores under 13 reflected low CR levels, scores between 13 and 16 reflected medium levels, scores between 16 and 20 reflected high levels, and scores above 20 reflected superior levels. Education turned out to be the only predictor variable for the level of CR. Although differences were found between groups of different sex, this variable turned out to be not predictive. The CRQ-a is the first instrument for the Argentinian population to measure the level of the reserve. It allows to quickly explore different dimensions, considered as the most relevant for its formation. These are: formal education, courses, parents' formal education, employment, musical training, languages, reading activity and intellectual games. In patients with AD, is particularly important to have a measure for CR to prepare interventions for those subjects whose reserve levels are perceived as low, aiming to delay and, when possible, prevent the clinical manifestation of the disease. Its validation would open future lines of research on possible interventions for the prevention of diseases such as AD.

Tradução, validação cultural e semântica do cognitive reserve index questionnaire (CRIq) o português brasileiro / Cognitive reserve index questionnaire (CRIq) - translation, cultural and semantic validation for Brazilian portuguese

Introdução: A reserva cognitiva pode explicar diferentes respostas do indivíduo após acidentes ou doenças que acometem o sistema nervoso central. É importante ter instrumentos que avaliem tal reserva, não só para serem utilizados quando ocorrem problemas, mas também para avaliar indivíduos de forma profilática, visando o estabelecimento de programas de estimulação cognitiva. Objetivo: Obter a equivalência semântica e cultural do Cognitive Reserve Index questionnaire (CRIq) para o português brasileiro. Método: o questionário foi traduzido por dois tradutores independentes, do italiano para o português brasileiro. Após, foi produzida uma versão única, sintetizada, que foi retrotraduzida para o italiano, novamente por outros dois tradutores, independentes e sem conhecimento das traduções anteriores. A partir das traduções e retrotraduções, foi desenvolvida uma versão semanticamente aceitável para o português, que foi aplicada a 30 pessoas (grupo piloto). A partir desta aplicação foi criada uma nova versão, adaptada culturalmente para o português brasileiro. Resultados: As adaptações foram feitas especialmente na seção que avalia atividades laborativas ao longo da vida (CRIq trabalho) e principalmente no CRI tempo livre. Acredita-se que tais mudanças foram necessárias devido às diferenças culturais no que se refere às atividades realizadas como lazer por italianos e brasileiros. Os resultados obtidos no grupo piloto evidenciaram que houve correlação entre a RC, a idade (r=0,92, p=0,02*) e a escolaridade (r=0,70, p=0,00*). Conclusão: o Cognitive Reserve Index questionaire (CRIq) está traduzido e adaptado para o português brasileiro, sendo uma ferramenta útil para os profissionais que atuam na área, especialmente quando são avaliados indivíduos idosos.(AU)

Introduction: Cognitive reserve can explain the differences among patients' responses after accidents or diseases that affect the central nervous system. It is important to have instruments that assess this reserve, not only to address problems but also to provide individual prophylactic measures through the establishment of cognitive stimulation programs. Objective: To produce the semantic and cultural equivalent of the Cognitive Reserve Index questionnaire (CRIq) in Brazilian Portuguese. Method: The questionnaire was translated by two independent translators, from Italian to Brazilian Portuguese. Afterward, a single, synthesized version was produced and two other independent translators, who were unaware of the previous translations, back-translated it into Italian. From the translations and backtranslations, a semantically acceptable version was produced in Brazilian Portuguese and tested on 30 participants (pilot group). Based on this test, a new version was created that was culturally adapted to Brazilian Portuguese. Results: The section that evaluates work activities throughout life (CRIq work) required the most adaptation, particularly CRIq free time. Such changes may have been necessary due to cultural differences in leisure activities between Italians and Brazilians. The results obtained in the pilot group showed that there was a correlation between CR, age (r = 0.92, p = 0.02 *) and education (r = 0.70, p = 0.00 *). Conclusion: The Cognitive Reserve Index questionnaire (CRIq) has been appropriately translated and adapted into Brazilian Portuguese and may serve as a useful tool for health care professionals, especially those who assess elderly individuals.(AU)

Cognitive Reserve in Older Adults: A Cluster Analysis / Reserva Cognitiva em Adultos Idosos: Uma Análise de Cluster

Abstract Cognitive reserve (CR) is a construct generally associated with neurodegenerative diseases in aging. The aim of this paper was to examine the CR profiles of older adults at different stages of their lifespan and evaluate the importance of: (a) gender and CR; and (b) CR, cognition, and symptoms of depression. A sample of 195 older adults volunteered to participate in the study, and a cluster analysis was carried out on their responses in terms of the Cognitive Reserve Scale. The cluster analysis depicted two different profiles. Furthermore, women had a better CR than men. The results provide an important contribution to understanding the variables related to the CR construct.

Resumo A reserva cognitiva (RC) é um construto geralmente associado a doenças neurodegenerativas no envelhecimento. O objetivo deste estudo foi examinar os perfis de RC em adultos idosos em diferentes estágios da vida, e avaliar o efeito de: (a) gênero e RC; e (b) RC, cognição e sintomas depressivos. A amostra contou com 195 adultos, e uma análise de cluster foi realizada a partir dos escores obtidos na Escala de Reserva Cognitiva. A análise de cluster descreveu dois perfis diferentes. Além disso, as mulheres apresentaram maior RC em comparação aos homens. Os resultados fornecem contribuições importantes para as variáveis relacionadas ao construto da RC.

Asociación entre nivel educacional y sospecha de deterioro cognitivo en personas mayores chilenas: resultados de la Encuesta Nacional de Salud 2016-2017 / Association between educational level and suspicion of cognitive imparirment in Chilean older people

BACKGROUND: A low education level has been associated with cognitive impairment in older adults. AIM: To determine the association between educational attainment and suspicion of cognitive imparirment in older Chilean population. MATERIAL AND METHODS: Data from 2,005 adults aged ≥ 60 years assessed during 2016-2017 Chilean National Health Survey were included. Education was self-reported and categorized as primary: ≤ 8 years; secondary: 9 to 12 years and beyond secondary: > 12 years. suspicion of cognitive imparirment was assessed with the Mini-Mental questionnaire. RESULTS: Men and women with low education attainment had a higher prevalence of cognitive impairment (33% [95% confidence intervals (CI): 24; 41] and 27% [95% CI: 21; 33], respectively). Men who reported less schooling (≤ 8 years) were more likely to be at risk of suspicion of cognitive imparirment (Odds ratio (OR): 4.53 [95% CI: 1.10, 18.62]) compared to their peers. Women showed a substantially higher magnitude of association than men. The probability of suspicion of cognitive imparirment increased 9-times (OR: 9.96 [95% CI: 1.24; 79.6]) for 9-12 years and 18-times for ≤ 8 years of education (OR: 18.8 [95% CI: 2.42; 146.1]) compared to women with higher education. CONCLUSIONS: Older adults with low education attainment had an increased likelihood of developing suspicion of cognitive imparirment. However, the risk differs by sex, being higher in women than men.

El rol de las actividades del tiempo libre en la reserva cognitiva en adultos mayores / The Role of Leisure Activities in the Cognitive Reserve of Seniors / O papel das atividades de lazer na reserva cognitiva em idosos

La participación en actividades de ocio puede prevenir el deterioro cognitivo. El objetivo del presente trabajo es analizar a través de un modelo de ecuaciones estructurales, el peso relativo que tiene la participación en actividades del tiempo libre en cuatro dominios cognitivos: memoria episódica verbal, lenguaje, funciones ejecutivas y funciones atencionales en adultos mayo-res autoválidos. Para ello, se llevó a cabo un análisis de senderos, utilizando el procedimiento de ecuaciones estructurales (sem) en 167 participantes mayores (m= 72.34 años, de= 5.07 años) independientes en actividades de la vida diaria. Todos fueron evaluados con cuestionario de datos sociodemográficos, cuestionario de participación social y una batería neuro-psicológica de pruebas de uso frecuente en el ámbito clínico para memoria, lenguaje, funciones atencionales y funciones ejecutivas. Los resultados obtenidos indican que el factor de actividades muestra efectos significativos sobre el factor de funciones ejecutivas (ß = .45, p < .001, R2 = .20), también sobre el factor de memoria (ß = .38, p < .001, R2 = .14), al igual que con el factor de lenguaje (ß = .45, p < .001, R2 = .20) y el factor funciones atencionales (ß = .44, p = .03, R2 = .20). Estos resultados concuerdan con los de otros estudios que indican que las actividades de ocio podrían desempeñaron papel diferencial e importante en la construcción de la reserva cognitiva a lo largo del ciclo de vida, conformando un posible factor de protección cognitiva en el proceso de envejecimiento

Participation in cognitively demanding leisure activities can prevent cognitive decline. The objective of the present work is to analyze through a structural equation model (sem) the relative weight that partici-pation in leisure time activities has in three cognitive domains: episodic verbal memory, language execu-tive functions, and attentional functions in self-validated seniors. A path analysis was carried out using the semin 167 elderly participants (m=72.34 years, sd=5.07 years), independent in activities of daily living. All the participants were evaluated with a sociodemographic data questionnaire, a social participation questionnaire, and a neuropsychological battery of neuropsycho-logical tests frequently used in the clinical setting for memory, language, attentional functions, and executive functions. The results obtained indicate that the activities factor shows significant effects on the executive functions factor (ß=.45, p<.001, R2=.20), also on the memory factor (ß=.38, p<.001, R2=.14), as well as on the language factor (ß=.45, p<.001, R2=.20) and the attentional functions factor (ß=.44, p=.03, R2=.20). These results coincide with those of other studies that indicate that leisure activities could play a differential and important role in the construction of cognitive reserve throughout the life cycle, forming a possible cognitive protection factor in the aging process.

A participação em atividades de lazer pode prevenir o declínio cognitivo. O objetivo do presente trabalho é analisar, por meio de um modelo de equações estruturais, o peso relativo que a participação em atividades de lazer exerce em quatro domínios cognitivos: memória verbal episódica, linguagem, funções executivas e funções atencionais em idosos autovalidados. Foi realizada uma análise de trilha por meio do procedimento de equações estruturais (sem) em 167 idosos (m= 72.34 anos, dp = 5.07 anos), independentes nas atividades de vida diária. Todos os participantes foram avaliados com: questionário de dados sociodemográficos, questionário de participação social e uma bateria neurop-sicológica de testes neuropsicológicos frequentemente utilizados em âmbito clínico para: memória, linguagem, funções atencionais e funções executivas. Os resultados obtidos indicam que o fator atividade apresenta efeitos significativos sobre o fator funções executivas (ß = 0.45, p < 0.001, R2 = 0.20), também sobre o fator memória (ß = 0.38, p < 0.001, R2 = 0.14), assim como no fator linguagem (ß = 0.45, p < 0.001, R2 = 0.20) e sobre o fator funções atencionais (ß = 0.44, p < 0.03, R2 = 0.20). Estes resultados são corroborados por outros estudos que indicam que as atividades de lazer podem desempenhar um papel diferencial e importante na construção da reserva cognitiva ao longo do ciclo vital, constituindo um possível fator de proteção cognitiva no processo de envelhecimento.

O impacto das atividades cognitivas no desempenho no Mini-Mental de idosos octogenários de São João del Rei/MG: um estudo piloto / The impact of cognitive activities in the Mini-Mental performance of octogenarian elderly in the city of São João del Rei/MG: a pilot study

O aumento da população idosa mundial em torno de 600% nos últimos 50 anos trouxe vários desafios. O principal é a adoção de políticas que possam oferecer um envelhecimento saudável, preservando a autonomia dos sujeitos. Entre essas estratégias, a estimulação cognitiva é uma que possui baixo custo operacional e pode otimizar as funções que ainda se encontram preservadas. O objetivo desse estudo piloto retrospectivo foi avaliar o impacto protetivo das práticas de estimulação cognitiva em octogenários da cidade de São João del Rei. Para tanto foram aplicados dois instrumentos de avaliação: o Mini-Mental e um Questionário de Práticas Cognitivas. Os resultados preliminares indicam uma tendência de as práticas cognitivas impactarem positivamente no desempenho no Mini-Mental dos octogenários (p<0.01). Tais resultados têm implicações diretas, sobretudo nas estratégias de baixo custo a serem implementadas com o objetivo de se construírem reservas cognitivas na população recém adentrada na 3ª idade, visando uma maior autonomia na 4ª idade.

The increase in the world's elderly population of around 600% in the last 50 years has brought many challenges. The main one is adopting policies that can offer healthy aging, preserving the subjects' autonomy. Among these strategies, the cognitive stimulation is one that has a low operational cost and can optimize the functions which are still preserved. This retrospective pilot study aimed at evaluating the impact of cognitive stimulation practices on octogenarian elderly in the city of São João del Rei. Therefore, two evaluation instruments were applied: Mini-Mental and a Cognitive Practice Questionnaire. The preliminary results indicate a tendency that the cognitive practices impact positively on the octogenarians' cognitive performance(p<0.01). Such results have direct implications especially on the low-coststrategies to be implemented aiming at building cognitive reserves in the population of the recent 3rd age viewing a bigger autonomy in the 4th age.

Factores de riesgo cardiometabólico y funcionamiento cognitivo: el rol de la reserva cognitiva / Association between cardiometabolic risk and cognitive impairment

Background: Several risk factors are associated with cognitive impairment in older people, but little attention has been paid to cardiometabolic variables, as well as how cognitive reserve can mediate this association. Aim: To determine the association of cardiometabolic risk factors with cognitive functioning and whether the cognitive reserve mediates this association. Material and Methods: A cross-sectional study with 300 participants with a median age of 56 years (53% male) was conducted. Participants had a cognitive functioning assessment. Fasting glucose, HDL-cholesterol, and blood pressure were measured. Results: A Structural Equation Modeling, revealed a direct effect of cardiometabolic latent risk factors on both a cognitive functioning (β = -.204; p = .056), and cognitive reserve factors (β = -.236, p = .04). Cognitive reserve was directly associated with cognitive functioning (β = .327, p = .01), but did not mediate the association between the cardiometabolic risk factors and cognitive functioning (β = .077, p = .07). The overall goodness of fitness was excellent χ2 (50) = 58.357, p = .195, comparative fit index = .980, Tucker-Lewis Index = .974, root mean square error of approximation = .023 and Standardized Root Mean Square Residual = .041. Conclusions: A direct effect of cardiometabolic risk factors on cognitive functioning was observed.

Research progress on bilingualism and Alzheimer's disease / 中华老年医学杂志

Alzheimer's disease(AD)is the most common type of dementia.It is of great significance to systematically explore the interaction between bilingualism and AD for patients' cognitive rehabilitation and reduction of the burden on patients' families and society.Based on our literature review, bilingualism may be a beneficial factor for cognitive reserve helping to delay the onset of AD and thus exert positive effects mitigating the decline in patients' cognitive ability such as memory, executive control and visuospatial function.In turn, AD can impair patients' bilingual ability to varying degrees.In future research, more efforts should be directed toward elucidating the influence of bilingual characteristics, the age of second language acquisition, second language proficiency and other factors on AD as well as the influence of AD on patients' attention, emotional cognition and social cognition.

Promotores de reserva cognitiva en adultos mayores con alto riesgo de demencia cortical / Promoters of Cognitive Reserve in the Elderly with High Risk of Cortical Dementia

Introducción: La reserva cognitiva constituye un elemento central para entender cómo responde el cerebro a la neuropatología durante el ciclo vital. Objetivo: Comprender los factores promotores de reserva cognitiva desde la experiencia de vida de adultos mayores sin deterioro cognitivo y con alto riesgo de demencia cortical. Métodos: Estudio cualitativo, con base en método Grounded Theory. Se realizan entrevistas semiestructuradas en profundidad a siete adultos mayores. En el análisis, se aplica la técnica de comparación constante según modelo de Glasser y Straus, utilizando Atlas ti/7. Resultados: Desde el análisis axial surgen cinco categorías interrelacionadas: actividad mental, experiencias gratificantes, cuidados, eventos traumáticos y características de personalidad. Se aprecia un patrón constante de experiencias vitales mentalmente estimulantes, relacionado principalmente a actividades de cuidado y experiencias gratificantes, no asociadas a educación formal. Conclusiones: Se distingue un proceso dinámico que involucra experiencias y eventos de vida cotidiana, tanto personales como ambientales, ocupacionales y del estilo de vida, que operan secuencialmente durante el ciclo vital; estos factores podrían incidir significativamente en los mecanismos neurobiológicos y actuar como promotores de reserva cognitiva. Se obtiene un modelo de promotores de reserva cognitiva que podría utilizarse en programas de salud cognitiva para contrarrestar la neuropatología(AU)

Introduction: Cognitive reserve constitutes an element central to understanding how the brain responds to neuropathology during the life cycle. Objective: To understand the factors that promote cognitive reserve from the life experience of the elderly without cognitive deterioration and with high risk of cortical dementia. Methods: Qualitative study, methodologically based on grounded theory. In-depth semi-structured interviews are conducted on seven elderlies. In the analysis, the constant comparison technique is applied according to the model by Glaser and Strauss, using ATLAS-Ti 7. Results: Five interrelated categories emerge from the axial analysis: mental activity, gratifying experiences, care, traumatic events, and personality traits. There is a constant pattern of mentally-stimulating life experiences, mainly related to care activities and gratifying experiences, not associated with formal education. Conclusions: A dynamic process is distinguished that involves experiences and events of daily life, both personal and environmental, occupational and related to lifestyle, which operate sequentially during the life cycle. These factors could significantly influence neurobiological mechanisms and act as promoters of cognitive reserve. A model of cognitive reserve promoters is obtained that could be used in cognitive health programs to counteract neuropathology(AU)

Reserva cognitiva e os diferentes perfis de ganho cognitivo em idosos: uma scoping review / Cognitive reserve and the different cognitive gain profiles in the aged: a scoping review / Reserva cognitiva y los perfiles diferentes de ganancia cognitiva en los ancianos: una escopulación de revisión

O objetivo desse estudo foi verificar diferentes perfis de ganho cognitivo em idosos para a reserva cognitiva. Trata-se de uma scoping review, utilizando-se PubMed, Medline, Web of Science, Science Direct, Lilacs, SciELO, PsycInfo, PsycNet e AgeLine como base de dados; restringiu-se à busca entre o ano de 2008 e 2018. Identificou-se 2295 estudos e 51 foram elegíveis para a revisão. Dentre os 51 estudos selecionados, encontrou-se nove perfis diferentes para manutenção cognitiva, sendo que cinco estudos não especificaram o perfil. Como conclusão, os perfis encontrados representaram relevância para a teoria de reserva cognitiva e forneceram esclarecimentos de como fatores individuais e de vida diária podem fazer o cérebro mais resiliente no envelhecimento e na velhice; no entanto, esses fatores individuais e o modo como eles contribuem para o desenvolvimento da reserva cognitiva e da manutenção da cognição ainda permanecem obscuros na literatura.

The objective of this study was to verify different profiles of cognitive gain in the elderly for cognitive reserve. This is a scoping review, using PubMed, Medline, Web of Science, Science Direct, Lilacs, SciELO, PsycInfo, PsycNet and AgeLine as a database; the search was restricted between 2008 and 2018. 2295 studies were identified and 51 were eligible for the review. Among 51 studies selected, 9 different profiles were found for cognitive maintenance, and 5 studies did not specify the profile. Conclusion: The profiles found were relevant to cognitive reserve theory and provide insights into how individual factors and daily life can make the brain more resilient in aging and old age. However, those individual factors and how they contribute to development of cognitive reserve and maintenance of cognition still remain obscure in the literature.

El objetivo de este estudio fue verificar diferentes perfiles de ganancia cognitiva en ancianos para la reserva cognitiva. Se trata de una escopulación de revisión, utilizando PubMed, Medline, Web of Science, Science Direct, Lilacs, SciELO, PsycInfo, PsycNet y AgeLine como base de datos, restringiendo entre el año 2008 y el 2018. Se identificaron 2295 estudios y 51 fueron elegibles para la revisión. De los 51 estudios seleccionados, se encontraron 9 perfiles diferentes para el mantenimiento cognitivo, siendo que 5 estudios no especificaron el perfil. Conclusión: Los perfiles encontrados representaron relevancia para la teoría de reserva cognitiva y proporciona aclaraciones de cómo factores individuales y de vida diaria pueden hacer el cerebro más resistente en el envejecimiento y en la vejez, sin embargo, estos factores individuales y de cómo contribuyen al desarrollo de la reserva cognitiva y del mantenimiento de la cognición, todavía permanecen obscuras en la literatura.

Reserva Cognitiva: revisión de su conceptualización y relación con la Enfermedad de Alzheimer / Cognitive Reserve: a revision of its conceptualization and its relation with Alzheimer´s Disease

Introducción: La reserva cognitiva permite la activación de conexiones sinápticas adicionales y nuevas redes neurales frente a demandas del ambiente. Objetivo: Delimitar qué variables contribuyen a la formación de la reserva cognitiva y establecer su expresión en el desarrollo de la Enfermedad de Alzheimer. Metodología: Revisión bibliográfica sistemática y evaluativa de tipo cualitativa. Resultados: La educación, actividades de ocio, estilo de vida, estatus socioeconómico e inteligencia son las principales variables que aportan a la formación de la reserva cognitiva. Sujetos con alta reserva tienen menor prevalencia e incidencia de demencia. Aquellos que lleguen a desarrollar la enfermedad lo harán a una edad más tardía y con mayor severidad de síntomas. Conclusión: Las variables que contribuyen a la formación de la reserva cognitiva son, principalmente, variables socio-ambientales. La reserva se considera factor de protección frente a la enfermedad. Además, atrasaría la aparición de la demencia, logrando, en algunos casos, que nunca se llegue a desarrollar la enfermedad(AU)

Introduction: Cognitive reserve allows the activation of additional synaptic connections and new neural networks against environmental demands. Objective: Establish the variables that contribute to the formation of cognitive reserve and its expression in relation with Alzheimer´s Disease. Method: Systematic and evaluative review of qualitative type. Results: Education, leisure activities, lifestyle, socioeconomic status and intelligence are the main variables which contribute to the formation of cognitive reserve. Subjects with high reserve have lower prevalence and incidence of dementia. Those who develop Alzheimer´s Disease will do so at a later age and with more severe symptoms. Conclusions: The variables which contribute to the formation of cognitive reserve are, mainly, socio-environmental variables. The reserve is considered a protective factor against disease. It delays the onset of dementia avoiding, in some cases, the development of the pathology(AU)

Social engagement as a measurement of cognitive reserve and how it relates to different cognitive skills in college students / Compromisso social como medida de reserva cognitiva e sua relação com diferentes processos cognitivos em jovens universitários / Compromiso social como medida de reserva cognitiva y su relación con distintos procesos cognitivos en jóvenes universitarios

Abstract Greater social engagement is commonly associated with more efficient cognitive processing, as it improves cognitive reserve. The aim of this research is to assess the relationship between social engagement (in the dimensions of social contact, support and conflict) and certain cognitive skills (cognitive flexibility, planning, verbal fluency, processing speed, and verbal comprehension) in young college students. This cross-sectional rank correlation study was carried out in a sample of 49 college students. Spearman's rank correlation coefficient showed relationship between: social contact and verbal fluency (r = -.299, p = .037); social support and planning (r = .368, p = .009); and social conflict and processing speed (r = .306, p = .032). The results outline a measurable relationship between social engagement and certain cognitive skills, even when said results are not entirely conclusive. Thus, the need for more detailed studies on these processes becomes clear.

Resumo A literatura científica indica que um maior compromisso social está relacionado com um pensamento cognitivo mais eficiente, devido ao fato de que tal compromisso aumenta a reserva cognitiva. Levando isso em consideração, o objetivo da presente pesquisa foi identificar a relação existente entre o compromisso social (em suas dimensões de contato, apoio e conflito social) e alguns processos cognitivos (como flexibilidade mental, planejamento, fluidez verbal, velocidade de processamento e compreensão verbal) em jovens universitários. Para tanto, realizou-se um estudo correlacional com um desenho transversal em uma amostra de 49 estudantes. A análise de correlação de Spearman revelou correlações entre contato social e fluidez verbal (r = -.299, p = .037), apoio social e planejamento (r = .368, p = .009) e conflito social e velocidade de processamento (r = .306, p = .032). Esses resultados constituem uma associação entre o compromisso social e algumas funções cognitivas. Apesar dos resultados não serem completamente conclusivos, fica clara a necessidade de um estudo mais detalhado desses processos.

Resumen La literatura científica indica que un mayor compromiso social se relaciona con un procesamiento cognitivo más eficiente, debido a que dicho compromiso incrementa la reserva cognitiva. Teniendo esto en cuenta, el objetivo de la presente investigación fue identificar la relación existente entre el compromiso social (en sus dimensiones de contacto, apoyo y conflicto social) y algunos procesos cognitivos (como flexibilidad mental, planeación, fluidez verbal, velocidad de procesamiento y comprensión verbal) en jóvenes universitarios. Para esto, se realizó un estudio correlacional con un diseño transversal en una muestra de 49 estudiantes. El análisis de correlación de Spearman reveló correlaciones entre contacto social y fluidez verbal (r = -.299, p = .037), apoyo social y planeación (r = .368, p = .009), y conflicto social y velocidad de procesamiento (r = .306, p = .032). Estos resultados perfilan una asociación entre el compromiso social y algunas funciones cognitivas. A pesar de que los resultados no son del todo concluyentes, queda claro que se necesita de un estudio más detallado de estos procesos.

Anatomic and neuropsychological findings in low-educated cognitively intact elderly from a Brazilian cohort / Achados Anatômicos e Neuropsicológicos de Idosos Cognitivamente Saudáveis com Baixa Escolaridade em uma Coorte Brasileira

ABSTRACT In elderly individuals, low educational level may represent a risk factor for the development of dementia and a proxy of cognitive reserve. Objective: This study examined the cognitive and neuroanatomic correlates of high versus low educational levels in cognitively healthy community-dwelling older adults in Brazil. Methods: Fifty-three older adults (mean age: 68±5.3 years) were divided into a "low education" group [LE; 1-4 years of education (N=33)] and "high education" group [HE; >11 years of education (N=20)]. Both groups completed a comprehensive neuropsychological battery and underwent in vivo structural MRI close to the time of testing. Results: Higher educational level increased the chance of having better scores on neuropsychological tests, including verbal and visual delayed recall of information, verbal learning, category fluency, global cognition, and vocabulary. Better scores on these tests were observed in the HE group relative to the LE group. Despite this, there were no group differences between MRI measures. Conclusion: Older adults with higher educational levels showed better scores on neuropsychological measures of cognition, highlighting the need for education-adjusted norms in developing countries. Given the absence of differences in structural anatomy between the groups, these findings appear to be best explained by theories of cognitive reserve.

RESUMO Sabe-se que baixos níveis de educação são comuns em países em desenvolvimento. Em indivíduos idosos, em particular, baixos níveis de educação podem representar um fator de risco para o desenvolvimento de demência. Objetivo: Este estudo examina os correlatos cognitivos e neuroanatômicos de escolaridade alta versus baixa, em idosos cognitivamente saudáveis,vivendo em comunidade no Brasil. Métodos: Cinquenta e três idosos (média de idade: 68±5,3) foram divididos em um grupo de "baixa escolaridade" [LE; 1-4 anos de escolaridade (N=33)] e um grupo de "alta escolaridade" [HE; >11 anos de escolaridade (N=20)]. Ambos os grupos completaram uma bateria neuropsicológica abrangente e foram submetidos à RM estrutural in vivo próximo à testagem. Resultados: O nível educacional aumentou a chance de se obter melhores pontuações em testes neuropsicológicos, incluindo evocação verbal e visual da informação, aprendizagem verbal, fluência de categoria, cognição global e vocabulário. Escores mais altos foram encontrados no grupo HE, em detrimento do LE. Apesar disso, não houve diferenças entre os grupos nas medidas de ressonância magnética in vivo. Conclusão: Idosos com maiores níveis de escolaridade apresentaram melhores pontuações nas medidas neuropsicológicas da cognição, destacando a necessidade de normas ajustadas à educação nos países em desenvolvimento. Não havendo diferenças na anatomia estrutural entre os grupos, os achados parecem ser melhor explicados pelas teorias da "reserva cognitiva".

Reserva cognitiva y demencias: Limitaciones del efecto protector en el envejecimiento y el deterioro cognitivo / Limited protective effects of cognitive reserve on the progression of cognitive impairment

Aging constitutes a series of physical, physiological and cognitive changes, affecting independence in the activities of daily living. During this stage, neurodegenerative diseases and cognitive impairment are common. Cognitive Reserve allows to face neuropathological changes and maintain cognitive function in the presence of brain damage. However, there are cases where a high cognitive reserve fails to attenuate and delay the effects of neuropathology, allowing the progression of cognitive damage to advanced stages. The objective of this systematic review is to identify evidence where high cognitive reserve does not limit the effects of cognitive impairment. Results indicate that the protective effect of cognitive reserve occurs only in the presence of minimal cognitive impairment, but not at later stages.

Reserva Cognitiva e Abertura à Experiência em idosos sem demência: um estudo correlacional / Cognitive reserve and openness to experience in non-demented elderly people: a correlational study / Reserva cognitiva y apertura a la experiencia en ancianos sin demencia: un estudio correlacional

O objetivo deste artigo foi investigar acerca da Reserva Cognitiva (RC) e da Abertura à Experiência (AE) em idosos sem demência. Trata-se de uma pesquisa de campo, descritiva, correlacional e quantitativa, da qual participaram 31 idosos divididos em dois grupos: Saudável e Comprometimento Cognitivo Leve (CCL). Houve correlação moderada, positiva e significativa (r = 0,463; p < 0,01) entre RC e AE. Percebeu-se que os idosos saudáveis (M = 0,53; DP = 0,10) apresentaram significativamente [t = (29) 3,785; p < 0,01] maior índice de RC em comparação aos idosos com CCL (M = 0,39; DP = 0,11). Os dados confirmaram que existe associação entre RC e AE, e que idosos saudáveis apresentam maior RC, comparados a idosos com CCL. Este estudo possibilitou conhecer possíveis relações e diferenças subjacentes ao processo de aquisição das reservas cognitivas e de fatores relativos a AE, podendo contribuir para que mais pesquisas sejam feitas, buscando maiores evidências no campo da ciência.

El objetivo de este trabajo fui investigar la Reserva Cognitiva (RC) y la Apertura a la Experiencia (AE) en ancianos sin demencia. Es una investigación de campo, descriptiva, correlacional y cuantitativa. Los participantes fueron 31 ancianos divididos en dos grupos: ancianos cognitivamente saludables (GS) y ancianos con deterioro cognitivo leve (DCL). Existió una correlación moderada, positiva y significativa (r = 0.463; p < 0.01) entre RC y AE. El GS (M = 0.53; SD = 0.10) presentó significativamente [t = (29) 3,785; p <0.01] mayor índice RC comparado con el DCL (M = 0.39; SD = 0.11). Los datos confirmaron que existió una asociación entre RC y AE, y que los ancianos cognitivamente sanos tuvieron una RC más alta en comparación con los ancianos con DCL. Este estudio permitió conocer las posibles relaciones y diferencias subyacentes al proceso de adquisición de reservas cognitivas y factores relacionados con la AE y puede contribuir a una mayor investigación, buscando mayor evidencia en el campo de la ciencia.

This paper aimed to analyze the relationship between Cognitive Reserve (CR) and Openness to Experience (OE) in non-demented elderly people. Descriptive, correlational and quantitative research was undertaken. The sample consisted of thirty-one elderly people divided into two groups: healthy and Mild Cognitive Impairment (MCI). There was a moderate, positive and significant correlation (r = 0.463; p < 0.01) between CR and OE. It was found that the healthy controls (M = 0.53; SD = 0.10) present significantly [t = (29) 3,785; p < 0.01] higher CR compared to the elderly with MCI (M = 0.39; SD = 0.11). The data confirm that there was an association between CR and OE and that healthy controls have higher CR compared to the MCI group. This study allowed to know possible relationships and differences underlying the acquisition process of cognitive reserves and factors related to OE and may contribute to further research, seeking more evidence in the field of science.

Medición de reserva cognitiva: estudio en una muestra de adultos chilenos / Cognitive reserve assessment: a study in a sample of chilean adults

Mayor reserva se asocia con resistencia al deterioro en sujetos con enfermedades neurodegenerativas. En personas sanas explica las diferencias interindividuales en el rendimiento de tareas. Medir los factores de reserva cognitiva permite contar con un índice numérico de la ganancia cognitiva acumulada por un sujeto. Este índice puede ser correlacionado con otras funciones cuantificables. El presente trabajo tiene como objetivo presentar los índices de reserva obtenidos por una población chilena en la aplicación del Cognitive Reserve Index Questionnaire (CRIq). Para ello 90 adultos (18-85 años) sin evidencias de trastorno cognitivo, de la región de Valparaíso-Chile, fueron entrevistados sobre actividades de estudio, laborales y de tiempo libre ejecutadas desde los 18 años.Los resultados muestran que los índices de reserva de los sujetos varían en función del tiempo de ejecución de actividades promotoras de reserva y no por su edad. Se encontraron diferencias estadísticamente significativas entre los grupos etarios. Estos resultados permiten concluir que la ejecución de actividades de estudio, laborales, sociales, entre otras aumenta los índices de reserva cognitiva, que es una variable diferenciadora entre individuos. La medición de dichos índices puede ser útil en un amplio campo de disciplinas (medicina, neurología, neuropsicología, educación, psicología, fonoaudiología, neurociencias y en las ciencias cognitivas en general).

A higher cognitive reserve is linked to higher resistance to deterioration among subjects suffering from neurodegenerative disorders. In healthy persons the cognitive reserve explains inter-individual differences in task performance. Measuring the cognitive reserve factors involves obtaining a numerical index of the cumulative cognitive gain accumulated by a subject. This index can be correlated with other measurable functions.This study was conceived to determine the reserve indexes accumulated by a Chilean sample, by means of the administration of the Cognitive Reserve Index Questionnaire (CRIq).In order to do so, 90 adults (18-85 years old) without evidence of cognitive disorder, living in Valparaíso region, Chile, were interviewed about their education, their work environment and their and leisure activities carried out since they were 18 years old.Results showed that reserve indexes of the subjects vary as a function of the time of execution of reserve-promoting activities, not age. Statistically significant differences were found among age-groups. These findings allow us to conclude that studying, working and engaging in social activities, among other things, increase the cognitive reserve indexes, which are a differentiating variable among individuals.The measurement of these indexes can be useful in a wide array of disciplines: medicine, neurology, neuropsychology, education, psychology, phonoaudiology, neurosciences and cognitive sciences in general.

Instruments for measuring cognitive reserve: a systematic review / Instrumentos de medida de reserva cognitiva: uma revisão sistemática / Instrumentos de medida de reserva cognitiva: una revisión sistemática

The Cognitive Reserve (CR) construct seeks to explain the brain's ability of compensate for degeneration caused by age or neuropathology. However, standardized measures of CR are incipient. Through a systematic review, this study aimed to investigate the instruments in the form of scales and questionnaires used as objective measures of CR, through the measurement of multiple variables related to activities conducted throughout the lifetime. The search for articles was conducted in the PubMed, Scopus, Science Direct, PsycINFO, VHL and Cochrane databases. Seven studies were selected after applying the inclusion and exclusion criteria. The existence of five scales/questionnaires that measure CR was verified. The instruments present a short duration, however, they vary in the items/variables measured, there being a lack of in-depth studies with large and diversified samples. Further studies are needed to improve the validity evidence and to conduct cross-cultural adaptations of the CR scale/questionnaires.

O construto reserva cognitiva (RC) busca explicar a capacidade de o cérebro compensar a degeneração causada pela idade ou neuropatologia. Contudo, medidas padronizadas de RC são incipientes. Por meio de uma revisão sistemática, este estudo objetivou investigar os instrumentos em formato de escalas e questionários utilizados como medida objetiva de RC, a partir da mensuração de múltiplas variáveis relacionadas a atividades realizadas ao longo da vida. A busca por artigos foi realizada nas bases de dados PubMed, Scopus, ScienceDirect, PsychINFO, BVS e Cochrane. Sete estudos foram selecionados após a aplicação dos critérios de inclusão e exclusão. Constatouse a existência de cinco escalas/questionários que mensuram RC. Os instrumentos são de curta duração, porém variam quanto aos itens/às variáveis mensuradas e carecem de estudos aprofundados, com amostras amplas e diversificadas. São necessários mais estudos que busquem aprimorar as evidências de validade e realizar adaptações transculturais das escalas/dos questionários de RC.

La Reserva cognitiva (RC) busca explicar la capacidad del cerebro para compensar el declive causado por la edad y neuropatologías. Además, las escalas estandarizadas de RC son aún incipientes. La presente revisión sistemática, tuvo como objetivo investigar los instrumentos utilizados para medir objetivamente la RC, a partir de la evaluación de diversas variables asociadas con actividades realizadas durante el ciclo vital. La búsqueda se realizó en las bases de datos PubMed, Scopus, Science Direct, PsycInfo, Bvs y Cochrane. Después de aplicar los criterios de inclusión y exclusión siete artículos fueron seleccionados. Se identificó cinco instrumentos que miden RC. Dichos instrumentos son de corta duración, pero varían en cuanto a los ítems evaluados y carecen de estudios con muestras más amplias y diversas. Es necesaria la elaboración de estudios que busquen mejorar la validez, así como realizar adaptaciones transculturales de las escalas de RC.

Cognitive reserve and dementia: a scientometric review / Reserva cognitiva e demência: uma revisão cientométrica

ABSTRACT. Research into cognitive reserve (CR) and dementia is advancing rapidly. This paper analyses the intellectual structure, emerging trends and relevant shifts in the development of available knowledge. Data collected from the Web-of-Science produced an expanded network of 564 articles and 12,504 citations in the 1998-2017 period. The co-citation network visualized was characterized by a scientometric review using CiteSpace. The results revealed that author Stern Y had the highest number of publications and citations. The network of journals, institutions and countries showed a central-peripheral structure with Neurology, Harvard University and the USA ranked first, respectively. While cognitive reserve remains the most prominent area of research in this field, studies related to functional ability, executive control, mortality data and reserve mechanisms have grown considerably. The identification of critical articles and the development of emerging trends highlights new insights in the area of research, better communicating key findings and facilitating the exploration of data.

RESUMO. A pesquisa em reserva cognitiva e demência avança rapidamente. Este artigo analisa a estrutura intelectual, tendências emergentes e mudanças relevantes no desenvolvimento do conhecimento coletivo. Dados coletados do Web-of-Science, construíram uma rede expandida de 564 artigos e 12.504 citações, entre 1998-2017. A rede de cocitação visualizada foi caracterizada através de uma revisão cientométrica utilizando o CiteSpace. Os resultados revelam Stern Y com o maior número de publicações e citações. A rede de revistas científicas, instituições e países apresenta uma estrutura central-periférica, respetivamente com Neurologia, Universidade de Harvard e EUA em primeiro lugar. Enquanto a reserva cognitiva continua a ser a área de pesquisa mais proeminente neste campo, estudos relacionados à capacidade funcional, controle executivo, dados de mortalidade e mecanismos de reserva têm experimentado um crescimento considerável. A identificação de artigos críticos e o desenvolvimento de novas tendências emergentes destacam novos insights sobre a área de pesquisa, comunicando melhor as principais descobertas e facilitando a exploração de dados.

Association Between Dental Implants and Cognitive Function in Community-dwelling Older Adults in Korea / 예방의학회지

OBJECTIVES: This study aimed to evaluate the association between dental implants and cognitive function in community-dwelling older adults. METHODS: Data were collected from the baseline survey (2016–2017) of the Korean Frailty and Aging Cohort Study. The study sample comprised 1115 community-dwelling people aged 70 years to 84 years who had 0-19 natural teeth. Dental implants and natural teeth were identified by panoramic radiography, while the cognitive function was assessed by the Korean version of the Mini-Mental State Examination (MMSE-KC). The association between dental implants and cognitive function was analyzed by multiple linear regression. Sensitivity analysis was performed to test for potential bias. RESULTS: The mean number of natural teeth in the study population was 9.50 (standard deviation [SD], 6.42), and the mean MMSE-KC score was 24.93 (SD, 3.55). In the simple univariate analysis, tooth replacement, age, sex, smoking status, alcohol consumption, body mass index, osteoporosis, number of natural teeth, periodontitis, chewing discomfort, tooth-brushing frequency, education level, monthly household income, participation in economic activity, living alone, and marital status had a significant impact on the association. After adjusting for confounders, the association between dental implants and cognitive function remained significant (B, 0.85; standard error, 0.40; p<0.05). Age, body mass index, periodontitis, tooth-brushing frequency, and education level were also significantly associated with cognitive function. The results of the sensitivity analyses were consistent with those of the primary analysis. CONCLUSIONS: Dental implants were associated with cognitive function in older adults living in the community. Dental implants as tooth replacements may play a role in preserving cognitive function.