Aim: The role of cognitive reserve (CR) in modulating dementia has been broadly investigated. We aimed to evaluate the long-term effects of CR on cognitive functions in outpatients newly treated with acetylcholinesterase inhibitors.

Method: Fifty older adults with dementia (age 80 ± 6.4 years) were followed up over 27 months. CR was assessed with the Cognitive Reserve Index questionnaire (CRIq), which provides a Total CR index and three proxy measures: Education, Working Activity and Leisure Time. The association between CR and cognition, evaluated by the Mini-Mental State Examination (MMSE), was tested through linear mixed models.

Results: The cognitive profile of High CR individuals (n = 16) was more fluctuating than that of patients with Low CR (n = 34) up to 15 months of treatment, showingan alternation of improvements and worsening. At linear mixed models, CRIq Total score was significantly associated with MMSE over the follow-up either when considered as continuous (β = 0.13 [95%CI:0.07–0.19], p < .001, per each 1-unit increase) orcategorical variable (β = 3.62 [95%CI:1.77–5.47], p = .002, High vs Low CR). Among the CR domains, higher CRIq Leisure-time scores were significantly associated with higher MMSE during the follow-up (β = 0.05 [95%CI:0.02–0.09], p = .009, per each 1-unit increase).

Conclusion: The study indicates that higher CR, and especially Leisure Time-related CR, was associated with better cognitive performance in older outpatients with dementia treated with AChEI for 27 months. These findings suggest that Leisure Time-related CR could influence the evolution of dementia, and support the need of further investigations to verify the potential usefulness of interventions enhancing such domain even in advanced age.

目的：认知储备（CR）在调节痴呆中的作用已得到广泛研究。我们旨在评估CR对乙酰胆碱酯酶抑制剂新治疗门诊患者认知功能的长期影响。

方法：对50名老年痴呆症患者（年龄80±6.4岁）进行了27个月的随访。CR用认知储备指数问卷（CRIq）进行评估，该问卷提供了总CR指数和三个替代指标：教育，工作活动和休闲时间。通过线性混合模型测试了由迷你精神状态检查（MMSE）评估的CR与认知之间的关联。

结果：长达15个月的治疗，高CR个人（n = 16）的认知状况比低CR患者（n = 34）的波动更大，表现出改善和恶化的交替。在线性混合模型中，CRIq总评分与随访中的MMSE显着相关，或者被认为是连续的（β= 0.13 [95％CI：0.07-0.19]，p <.001，每增加1个单位）或分类变量（β= 3.62 [95％CI：1.77–5.47]，p = .002，高CR与低CR）。在CR域中，随访期间较高的CRIq休闲时间得分与较高的MMSE显着相关（每增加1个单位，β= 0.05 [95％CI：0.02–0.09]，p = .009）。

结论：该研究表明，在AChEI治疗27个月的老年痴呆患者中，较高的CR，尤其是与休闲时间相关的CR与较好的认知表现有关。这些发现表明，与休闲时间相关的CR可能会影响痴呆症的发展，并支持进一步研究的需要，以验证即使在高龄时增强此类领域的干预措施的潜在有用性。