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Abstract
Objective To test the hypothesis that higher level of cognitive activity predicts older age at dementia onset in Alzheimer disease (AD) dementia.
Methods As part of a longitudinal cohort study, 1,903 older persons without dementia at enrollment reported their frequency of participation in cognitively stimulating activities. They had annual clinical evaluations to diagnose dementia and AD, and the deceased underwent neuropathologic examination. In analyses, we assessed the relation of baseline cognitive activity to age at diagnosis of incident AD dementia and to postmortem markers of AD and other dementias.
Results During a mean of 6.8 years of follow-up, 457 individuals were diagnosed with incident AD at a mean age of 88.6 (SD 6.4, range 64.1–106.5) years. In an extended accelerated failure time model, higher level of baseline cognitive activity (mean 3.2, SD 0.7) was associated with older age at AD dementia onset (estimate 0.026; 95% confidence interval 0.013–0.039). Low cognitive activity (score 2.1, 10th percentile) was associated with a mean onset age of 88.6 years compared to a mean onset age of 93.6 years associated with high cognitive activity (score 4.0, 90th percentile). Results were comparable in subsequent analyses that adjusted for potentially confounding factors. In 695 participants who died and underwent a neuropathologic examination, cognitive activity was unrelated to postmortem markers of AD and other dementias.
Conclusion A cognitively active lifestyle in old age may delay the onset of dementia in AD by as much as 5 years.
Glossary
- AD=
- Alzheimer disease;
- CI=
- confidence interval;
- MAP=
- Memory and Aging Project;
- NIA=
- National Institute on Aging;
- NINCDS/ADRDA=
- National Institute of Neurologic and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association;
- TDP-43=
- transactive response DNA-binding protein 43
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received January 28, 2021.
- Accepted in final form May 27, 2021.
- © 2021 American Academy of Neurology
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