Education, leisure activities and cognitive and functional ability of Alzheimer's disease patients: A follow-up study

Abstract

Education and participation in leisure activities appear to be highly relevant variables in Alzheimer's disease (AD) and usually form the basis of the Cognitive Reserve construct.OBJECTIVE[A] To determine the association between education, cognitive and functional ability of AD patients; [B] To determine the association between participation in leisure activities and cognitive and functional ability of AD patients; [C] To evaluate the association of education and participation in leisure activities in the course of AD.METHODSFunctional and neuropsychological abilities of 120 outpatients with probable AD were evaluated at baseline, at 36 and 54 months. Data collected at baseline included socio-demographics, clinical variables, education and frequency of participation in leisure activities throughout life. All participants and/or caregivers answered the questionnaire, "Participation in leisure activities throughout life" while patients completed the MMSE, the Clinical Dementia Rating scale, neuropsychological tests from the Lisbon Screening for Dementia Assessment, Barthel Index and Lawton and Brody's Index.RESULTSAD patients with higher levels of education achieved better results on cognitive tests. The participants with higher participation in leisure activities exhibited better results on cognitive and functional tests than those with lower participation. The disease progression was linear and progressed similarly regardless of the level of education of participants. However, the results suggest a slower disease progression in patients with a higher level of participation in leisure activities throughout their lives.CONCLUSIONAD patients with high education and high participation in leisure activities may benefit from a slower cognitive and functional decline after diagnosis of AD.

Cognitive reserve and the severity of Alzheimer’s disease

“…The results of this study confirm other studies' results have shown that higher levels of education are associated with better performance on cognitive tests 7,30 . The group "> 4 years" got better results on functional tests than the group of illiterates.…”

“…So, the level of CR influenced the severity of dementia. Education, occupation attainment and LA are the most commonly used proxies for CR and our study was consistent with other studies which showed that high levels of CR, education, high PLA and substantively complex work (eg, "Intermediate level professions, intellectual and scientific activity") influenced the rate of cognitive decline in persons with AD 7,11,12 .…”

“…A research has indicated that high PLA is associated with more rapid cognitive decline than in those with lower PLA 9 and some studies have shown that AD patients with higher education have a more rapid cognitive decline 3,10 than those with lower education, because at any level of clinical severity, the underlying progression is more advanced in patients with higher education, which has been attributed to harbouring a higher pathological burden at the time of clinical dementia for subjects with higher education 3 . Other authors 7,11 concluded that education slows the rate of cognitive decline in person with AD and Treiber and colleagues 12 proved that the increased engagement in cognitive LA through late life was associated with slower deterioration in general cognitive ability in mild dementia. Sobral and Paúl 7 found that AD patients with high education and high PLA may benefit from a slower cognitive and functional decline after diagnosis of AD.…”

Associação entre o desempenho de Atividades Avançadas de Vida Diária e a incidência de declínio cognitivo: Estudo SABE

“…Estudos longitudinais referem associação entre escores iniciais do MEEM com melhor função cognitiva (Perneczky et al, 2006;Sobral & Paúl, 2013) e velocidade de declínio em idosos com demência Castro-Costa et al, 2011), reforçando-se a importância do MEEM como teste de rastreio para a detecção de alterações das funções cognitivas. Pedrosa et al, 2010;Pinto & Neri, 2013;Reuben et al, 1990 A literatura também refere associação entre dificuldades em atividades instrumentais e básicas e prejuízos da função cognitiva (Njegovan et al, 200;Di Rienzo, 2009).…”

“…Além disso, contribuiria com a melhora das relações com os cuidadores, por meio da realização conjunta de atividades significativas que promovessem a busca e a preservação do senso de identidade. Não há consenso sobre quais atividades seriam, isoladamente, favorecedoras de estimulação cognitiva, devido à influência de alta subjetividade, variabilidade cultural e por serem gênero-específicas (Reuben et al, 1990 Apesar das diferentes classificações encontradas na literatura, a somatória do número de atividades complexas realizadas mostrou-se associada aos melhores níveis de função cognitiva e diminuição do risco de declínio cognitivo (Aartsen et al, 2002;Bassuk et al, 1999;Di Rienzo, 2009;Foubert-Samier et al, 2012;Gallucci et al, 2009;Glei et al, 2005;Iwasa et al, 2012;Li et al, 2013;Scarmeas et al, 2001;Sobral & Paúl, 2013;Zunzunegui et al, 2005). Os resultados desse estudo corroboram com os anteriores, onde a realização de um maior número de atividades diminuiu a incidência de declínio cognitivo, mesmo após ajuste pelas demais covariáveis e, principalmente, pela escolaridade.…”