Cognitive Functioning Mediates the Association of Cognitive Reserve with Health-Related Quality of Life

Abstract

We investigated whether the relations of the cognitive reserve markers education and cognitive level of work to the physical and the mental component of health-related quality of life (HRQoL) were mediated via cognitive functioning in a large sample of 701 older adults (mean age = 70.36 years, SD = 6.87). HRQoL was measured with the 12-item Short-Form Health Survey. To measure cognitive functioning, we used the COGTEL, which is a cognitive test battery assessing prospective memory, verbal short-term memory, verbal long-term memory, working memory, verbal fluency, and inductive reasoning, combined into a composite score. Individuals reported information on their education and their main profession during their working life. Mediation analyses showed that better cognitive functioning mediated the association of higher values in the cognitive reserve markers (longer education and a high cognitive level of work) with higher HRQoL. In conclusion, the present study suggests that the sustainability of cognitive functioning in old age with the help of cognitive reserve is fundamental for the sustainability of quality of life, presumably particularly for the mental HRQoL component.

Mediation effects of cognitive, physical, and motivational reserves on cognitive performance in older people

“…The results are in line with other studies that support the hypothesis that cognitive reserve influences the delay in the development of cognitive impairment symptoms. In a recent study done by Ihle et al (2022) , with a Portuguese population, it is evident that healthy cognitive functioning is mediated by cognitive reserve (measured with indicators of educational levels and types of professions) and perceived quality of life. This reinforces the important role of cognitive reserve in maintaining healthy aging, especially in its health-related quality of life (HRQoL) dimension.…”

A State-of-the-Art Review on the Role of Cognitive and Motor Reserve on Quality of Life: A Focus on Cardiovascular Patients in a Lifespan Perspective

“…According to Lara and colleagues [39], who measured CR in a sample of older healthy adults by considering the three main indicators previously highlighted (education, work and leisuretime activities), a higher CR was associated with higher QoL. Furthermore, considering the health-related aspect of QoL in line with previous findings, a more recent work by Ihle and colleagues [40] considered the association between CR, cognitive functioning and health-related quality of life (HRQoL) levels on a sample of healthy older adults. They reported that better cognitive functioning together with higher CR (operationalized by education and cognitive level required at work) is fundamental to sustaining perceived good QoL, particularly for the mental component related to health status.…”

“…Others have used comprehensive tools such as WHOQOL-AGE [ 45 ], which is specific for the older adult population [ 39 ]. Again, other studies (e.g., [ 40 ]) have focused on a specific construct that is very close to QoL, which is HRQoL. This alternative metric reflects an individual’s functioning in life with respect to their perceived well-being in the physical, mental and social domains of health [ 3 ].…”

“…Another reason that brings contrasting results can be found in the use of different tools and methods to operationalize CR. Considering only the studies mentioned, we can see that none of them used the same tool and the same proxies; some used CR questionnaires [ 40 ], which considers a large number of proxies of CR together (i.e., level of education, parental level of education, training courses, occupation, musical training, languages, reading activities and intellectual games [ 46 ]), whereas others used more than one tool (i.e., CR questionnaires and CRI-q) to collect more indicators at a time [ 42 , 43 ]. Lastly, others have used only single proxies or the union of more indicators without a specific instrument (i.e., educational level and occupational attainment [ 40 ], as well as premorbid IQ [ 41 ]).…”

The Protective Power of Cognitive Reserve: Examining White Matter Integrity and Cognitive Function in the Aging Brain for Sustainable Cognitive Health

“…Educational attainment has been proposed as a crucial factor in promoting CR, which can help the brain to withstand damage and maintain function as we age or experience injury. Numerous studies have demonstrated that individuals with higher levels of educational attainment have a lower incidence of dementia and better cognitive function in old age [90]. This positive effect may be attributed to the development of CR, which allows the brain to compensate for damage by using alternate or more efficient neural pathways.…”