Solving the Puzzle of Cognitive Reserve Effects on Cognitive Decline: The Importance of Considering Functional Impairment

Abstract

Aims: We investigated whether the longitudinal relation between cognitive reserve accumulated across the lifespan and rate of cognitive decline over 6 years differed by the individual's degree of functional impairment. Methods: We analyzed longitudinal data from 897 older adults (M = 74.33 years) tested on the Trail Making Test (TMT) in 2 waves 6 years apart. Results: There was a significant interaction of functional impairment with cognitive reserve on latent change in cognitive functioning. Specifically, with no functional impairment in the first wave of assessment, greater cognitive reserve accumulated across the lifespan significantly predicted a reduced cognitive decline over 6 years (i.e., smaller increase in TMT completion time). In contrast, with certain functional impairment (in at least some activities) in the first wave, greater cognitive reserve build-up predicted a steeper cognitive decline (i.e., larger increase in TMT completion time). Conclusion: Individuals with greater cognitive reserve accumulated across the lifespan show a reduced cognitive decline if they still have relatively little functional impairment, while they will show a steeper decline (compared to individuals with less cognitive reserve) as soon as functional impairment becomes substantial.