Effect of Cognitive Reserve on the Association of Vascular Brain Injury With Cognition: Analysis of the PURE and CAHHM Studies,Neurology

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Effect of Cognitive Reserve on the Association of Vascular Brain Injury With Cognition: Analysis of the PURE and CAHHM Studies
Neurology ( IF 9.9 ) Pub Date : 2021-10-26 , DOI: 10.1212/wnl.0000000000012765
Romella Durrani ₁ , Matthias G Friedrich ₁ , Karleen M Schulze ₁ , Philip Awadalla ₁ , Kumar Balasubramanian ₁ , Sandra E Black ₁ , Philippe Broet ₁ , David Busseuil ₁ , Dipika Desai ₁ , Trevor Dummer ₁ , Alexander Dick ₁ , Jason Hicks ₁ , Thomas Iype ₁ , David Kelton ₁ , Anish Kirpalani ₁ , Scott A Lear ₁ , Jonathon Leipsic ₁ , Wei Li ₁ , Cheryl R McCreary ₁ , Alan R Moody ₁ , Michael D Noseworthy ₁ , Grace Parraga ₁ , Paul Poirier ₁ , Sumathy Rangarajan ₁ , Dorota Szczesniak ₁ , Andrzej Szuba ₁ , Jean-Claude Tardif ₁ , Koon Teo ₁ , Jennifer E Vena ₁ , Katarzyna Zatonska ₁ , Anna Zimny ₁ , Douglas S Lee ₁ , Salim Yusuf ₁ , Sonia S Anand ₁ , Eric E Smith ₁

Affiliation

From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (R.D., E.E.S.) and Departments of Radiology and Clinical Neurosciences (C.R.M.), University of Calgary; Department of Medicine and Diagnostic Radiology (M.G.F.), McGill University, Montreal; Population Health Research Institute, Hamilton Health Sciences (K.M.S., K.B., D.D., S.R., K.T., S.Y., S.S.A.), Department of Medicine (K.M.S., K.B., S.R., K.T., S.Y., S.S.A.), Department of Electrical and Computer Engineering, School of Biomedical Engineering (M.D.N.), and Department of Health Evidence and Impact (K.T., S.Y., S.S.A.), McMaster University, Hamilton; Department of Molecular Genetics, Ontario Institute for Cancer Research (P.A.), Department of Medicine (Neurology) (S.B.), Sunnybrook Research Institute (S.B.), and Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medical Imaging, St. Michael's Hospital (A.K.), and Department of Medicine, ICES (D.S.L.), University of Toronto; Department of Preventive and Social Medicine, École de Santé Publique (P.B.), and Research Centre, Montreal Heart Institute (D.B., J.-C.T.), Université de Montréal; Research Centre (P.B.), CHU Sainte-Justine, Montreal; School of Population and Public Health (T.D.) and Department of Radiology, St. Paul's Hospital (J.L.), University of British Columbia, Vancouver; Division of Cardiology (A.D.), University of Ottawa Heart Institute, University of Ottawa; Atlantic PATH (J.H.), Dalhousie University, Halifax, Canada; Department of Neurology (T.I.), Government Medical College Thiruvananthapuram, India; Diagnostic Imaging (D.K.), Brampton Civic Hospital, William Osler Health System, Etobicoke; Faculty of Health Sciences (S.A.L.), Simon Fraser University, Burnaby, Canada; National Center for Cardiovascular Diseases (W.L.), Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China; Diagnostic Imaging (M.D.N.), St. Joseph's Health Care, Hamilton; Department of Medical Biophysics and Robarts Research Institute (G.P.), Western University, London; Institut de Cardiologie et de Pneumologie de Quebec (P.P.), Université Laval, Canada; Departments of Psychiatry (D.S.), Angiology (A.S.), Social Medicine (K.Z.), and General and Interventional Radiology and Neuroradiology (A.Z.), Wroclaw Medical University, Poland; and Cancer Research and Analytics (J.E.V.), Cancer Care Control Alberta, Alberta Health Services, Calgary, Canada.

Background and Objectives

To determine whether cognitive reserve attenuates the association of vascular brain injury with cognition.

Methods

Cross-sectional data were analyzed from 2 harmonized studies: the Canadian Alliance for Healthy Hearts and Healthy Minds (CAHHM) and the Prospective Urban and Rural Epidemiology (PURE) study. Markers of cognitive reserve were education, involvement in social activities, marital status, height, and leisure physical activity, which were combined into a composite score. Vascular brain injury was defined as nonlacunar brain infarcts or high white matter hyperintensity (WMH) burden on MRI. Cognition was assessed using the Montreal Cognitive Assessment Tool (MoCA) and the Digit Symbol Substitution Test (DSST).

Results

There were 10,916 participants age 35–81. Mean age was 58.8 years (range 35–81) and 55.8% were female. Education, moderate leisure physical activity, being in a marital partnership, being taller, and participating in social groups were each independently associated with higher cognition, as was the composite cognitive reserve score. Vascular brain injury was associated with lower cognition (β –0.35 [95% confidence interval [CI] –0.53 to –0.17] for MoCA and β –2.19 [95% CI –3.22 to –1.15] for DSST) but the association was not modified by the composite cognitive reserve variable (interaction p = 0.59 for MoCA and p = 0.72 for DSST).

Conclusions

Both vascular brain injury and markers of cognitive reserve are associated with cognition. However, the effects were independent such that the adverse effects of covert vascular brain injury were not attenuated by higher cognitive reserve. To improve cognitive brain health, interventions to both prevent cerebrovascular disease and promote positive lifestyles are needed.

中文翻译：

认知储备对血管性脑损伤与认知关联的影响：PURE 和 CAHHM 研究的分析

背景和目标

确定认知储备是否减弱血管性脑损伤与认知的关联。

方法

横断面数据分析来自两项协调研究：加拿大健康心脏和健康思想联盟 (CAHHM) 和前瞻性城乡流行病学 (PURE) 研究。认知储备的指标是教育程度、社交活动参与度、婚姻状况、身高和休闲体育活动，这些指标被合并成一个综合分数。血管性脑损伤被定义为非腔隙性脑梗塞或 MRI 上白质高信号 (WMH) 负担。使用蒙特利尔认知评估工具（MoCA）和数字符号替换测试（DSST）评估认知能力。

结果

共有 10,916 名年龄在 35 岁至 81 岁之间的参与者。平均年龄为 58.8 岁（范围 35-81），其中 55.8% 为女性。教育、适度的休闲体育活动、婚姻关系、身高和参与社会团体都与较高的认知独立相关，综合认知储备得分也是如此。血管性脑损伤与认知能力较低相关（MoCA 为 β –0.35 [95% 置信区间 [CI] –0.53 至 –0.17]，DSST 为 β –2.19 [95% CI –3.22 至 –1.15]），但这种关联并不存在由复合认知储备变量修改（MoCA 的交互作用p = 0.59， DSST 的交互作用p = 0.72）。

结论

血管性脑损伤和认知储备标志物都与认知相关。然而，这些影响是独立的，因此隐性血管性脑损伤的不利影响不会因较高的认知储备而减弱。为了改善大脑认知健康，需要采取干预措施来预防脑血管疾病并促进积极的生活方式。

更新日期：2021-10-26

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