Clinical dementia severity associated with ventricular size is differentially moderated by cognitive reserve in men and women

Shraddha Sapkota, Joel Ramirez, Donald T Stuss, Mario Masellis, Sandra E Black, Shraddha Sapkota, Joel Ramirez, Donald T Stuss, Mario Masellis, Sandra E Black

Abstract

Background: Interindividual differences in cognitive reserve (CR) are associated with complex and dynamic clinical phenotypes observed in cognitive impairment and dementia. We tested whether (1) CR early in life (E-CR; measured by education and IQ), (2) CR later in life (L-CR; measured by occupation), and (3) CR panel (CR-P) with the additive effects of E-CR and L-CR, act as moderating factors between baseline ventricular size and clinical dementia severity at baseline and across 2 years. We further examined whether this moderation is differentially represented by sex.

Methods: We examined a longitudinal model using patients (N = 723; mean age = 70.8 ± 9.4 years; age range = 38-90 years; females = 374) from the Sunnybrook Dementia Study. The patients represented Alzheimer's disease (n = 439), mild cognitive impairment (n = 77), vascular cognitive impairment (n = 52), Lewy body disease (n = 30), and frontotemporal dementia (n = 125). Statistical analyses included (1) latent growth modeling to determine how clinical dementia severity changes over 2 years (measured by performance on the Dementia Rating Scale), (2) confirmatory factor analysis to establish a baseline E-CR factor, and (3) path analysis to predict dementia severity. Baseline age (continuous) and Apolipoprotein E status (ɛ4-/ɛ4+) were included as covariates.

Results: The association between higher baseline ventricular size and dementia severity was moderated by (1) E-CR and L-CR and (2) CR-P. This association was differentially represented in men and women. Specifically, men in only the low CR-P had higher baseline clinical dementia severity with larger baseline ventricular size. However, women in the low CR-P showed the (1) highest baseline dementia severity and (2) fastest 2-year decline with larger baseline ventricular size.

Conclusions: Clinical dementia severity associated with ventricular size may be (1) selectively moderated by complex and additive CR networks and (2) differentially represented by sex.

Trials registration: ClinicalTrials.gov, NCT01800214 . Registered on 27 February 2013.

Keywords: Cognitive impairment; Cognitive reserve; Dementia; Sex; Sunnybrook Dementia Study; Ventricular size.

Conflict of interest statement

Ethics approval and consent to participate

All of this research has been approved continuously by relevant institutional review boards. Certificates are available from and on file at Sunnybrook Health Sciences Centre. All participants have completed and signed informed consent forms.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Conceptual model for baseline ventricular size on baseline Dementia Rating Scale (DRS) performance and 2-year change (A) independently, (B) as moderated by early-life cognitive reserve (E-CR), (C) as moderated by later-life cognitive reserve (L-CR), and (D) as moderated by cognitive reserve panel (CR-P = E-CR + L-CR). Apolipoprotein E (APOE) genotype and baseline age are included as covariates in all analyses. i Intercept, s Slope, T Time point, WAIS Wechsler Adult Intelligence Scale, NART North American Reading Test-Revised
Fig. 2
Fig. 2
Predicted growth curves for baseline ventricular size on Dementia Rating Scale performance and 2-year change as moderated by cognitive reserve panel (early-life cognitive reserve + later-life cognitive reserve) in the overall group: (a) low, (b) intermediate, and (c) high
Fig. 3
Fig. 3
Predicted growth curves for baseline ventricular size on Dementia Rating Scale performance and 2-year change as moderated by cognitive reserve panel (early-life cognitive reserve + later-life cognitive reserve) in men and women: (a) low, (b) intermediate, and (c) high

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