The impact of cognitive reserve relative to risk of Alzheimer's disease and rate of progression: an up-to-date review of the literature

Abstract

Introduction: Cognitive reserve (CR) is a crucial factor in explaining individual differences in the risk of Alzheimer's disease (AD) and cognitive decline. CR refers to the brain's ability to cope with pathology through compensatory mechanisms. This review examines the various methods used to measure, predict, and influence CR.

Areas covered: Based on a search of PubMed, PubMed Central, EMBASE, Scopus, and the Cochrane Library (up to 1 June 2024), this review addresses key CR proxies, highlighting their strengths and limitations. The review also explores established and emerging interventions. We critically evaluate the statistical methods used to measure CR and assess its practical application.

Expert opinion: CR plays a crucial role in delaying the onset and progression of AD. Lifestyle choices and experiences build CR and impact cognitive aging. However, practical challenges remain in applying CR in clinical settings, particularly in individuals with advanced cognitive decline. Education, while commonly used as a proxy for CR, may not fully capture its complexity. Alternatives like occupational complexity could offer more practical measures, but their application is still evolving. Addressing these limitations is key to advancing dementia prevention strategies.

Keywords: Aging; Alzheimer’s; brain reserve; cognition; cognitive decline; cognitive reserve; dementia; geriatrics.