There is two different ways to react to a disease like Mild cognitive impairment and Alzheimer’s disease, pathological and clinical. What if there was a way to delay the clinical expression of a disease through pathology? The cognitive reserve has been proven to show a more rapid decline in the individuals that had higher reserve. The purpose of this study was to see if the cognitive reserve actually had an impact on the outcome of Dementia and Alzheimer’s disease. A total of 53 patients with varying degrees of disease pathology and clinical symptoms participated in the study. The results demonstrated that the cognitive reserve makes an impact on the clinical expression, the individuals with high cognitive reserve have a delayed clinical expression comparatively with those with low reserve. Studies of the cognitive reserve may point the way to successful interventions that can help maintain successful aging and slow the onset of dementia.

Objective. This thesis examines the invariance of a battery of neuropsychological tests to known education-associated differences in strategy implementation and neural resource allocation underlying cognitive task performance in older adults without cognitive impairment. Methods. Confirmatory factor analysis was used to evaluate the fit of a three-factor measurement model (Verbal Ability, Visuospatial Ability, Long-term Retention; Tuokko et al., 2009) to scores from the neuropsychological battery of the Canadian Study of Health and Aging (CSHA) for the purpose of confirming the latent constructs measured by its 11 tests. Measurement equivalence of the model across lower- (LE; ≤8 years) and higher-educated (HE; ≥9 years) participants was then evaluated using invariance testing. Results. The measurement model demonstrated adequate fit across LE and HE samples but the loadings of the 11 tests (indicators) onto the three factors could not be constrained equal across groups. Two non-invariant tests of verbal ability (Animal fluency, token test) were identified that, when freed from constraints, produced an invariant model. Constraint of factor covariances did not compromise the partial invariance of this model. Because demographic characteristics of the LE and HE samples differed significantly, findings were replicated on age-and sex-matched subsamples. Conclusions. Two measures of verbal ability were not invariant across HE and LE samples of older adults, suggesting that the cognitive processes underlying performance on these tests may vary as a function of educational attainment. / Graduate

Hyperbaric Oxygenation Therapy (HBOT) has a successive history for treating very specific groups of physical conditions. Research by Neubauer and colleagues states that HBOT's ability to increase cerebral metabolism in the brain regenerates dormant neural tissue (Neubauer, Gottlieb, & Pevsner 1994). According to this research, the increase of cerebral metabolism levels restores mental capacity from the neurological insult. Despite promise, uncertainty exists as to whether this is a viable treatment option for people suffering from neural damage. The research results for this experiment will examine the effect of HBOT on cerebral metabolism levels in adults and pediatrics with chronic neurological problems. Fifty individuals diagnosed as having a neurological impairment whom met criteria for the study were analyzed from an archival data set. Criterion required chronic impairment, baseline SPECT, followed by HBOT exposures, and a post SPECT scan. Statistical analyses consisted of a Pearson correlation that examined pre-metabolism rates with total change, a Pearson correlation that examined total change and number of treatments, and a one way ANOVA analysis that examined cerebral metabolism change in patients under 18 and over 18. Results indicated change

Um dos desafios fundamentais para a pesquisa gerontológica é como manter e promover o funcionamento cognitivo preservado na velhice. O presente estudo está dividido em dois artigos. O primeiro artigo tem como objetivo verificar diferentes perfis de ganho cognitivo em idosos para a reserva cognitiva. Apresenta dados de uma scoping review sobre reserva cognitiva e os diferentes efeitos das intervenções realizadas. Foi realizado um levantamento de estudos publicados entre janeiro de 2008 até agosto de 2018, nas bases de dados PubMed, Medline, Web of Science, Science Direct, Lilacs, SciELO, PsycInfo, PsycNet e AgeLine usando as seguintes palavras-chave \"reserva cognitiva\" e {envelhecimento ou \"velhice\" ou \"pessoas velhas\" ou \"adultos idosos\"} e, os termos em inglês \"cognitive reserve\" AND {aging OR \"old age\" OR \"old people\" OR \"old adults\"}. Foram identificados 2295 estudos, 51 foram elegíveis para a scoping review. Dentro os 51 estudos selecionados, foram encontrados 9 perfis diferentes para manutenção cognitiva, sendo que 5 estudos não especificaram o perfil. Os perfis encontrados representam relevância para a teoria de reserva cognitiva e fornece esclarecimentos de como fatores individuais e de vida diária podem fazer o cérebro mais resiliente no envelhecimento e na velhice, porém, como os fatores individuais contribuem para o desenvolvimento da RC e manutenção da cognição, é uma questão ainda não explicada pela literatura. O segundo artigo dedicado à exposição do delineamento de uma pesquisa empírica, avalia a associação entre cognição e atividades avançadas de vida diária em uma amostra de idosos brasileiros residentes na comunidade, como forma de contribuir para o entendimento destes perfis para as melhoras em suas capacidades cognitivas. Tratou-se de uma análise transversal de 271 idosos, com 80 anos ou mais, participantes de uma fase de acompanhamento (2016-2017) de um estudo de base comunitária denominado FIBRA. A primeira onda de coleta de dados ocorreu entre 2008 e 2009. No estudo de acompanhamento, os domicílios dos participantes de dois locais, Campinas e Ermelino Matarazzo, foram revisitados e novos dados foram coletados daqueles que aceitaram participar dessa fase. Os participantes completaram um bloco de medidas que incluiu informações sociodemográficas, testes cognitivos Mini-Exame do Estado Mental (MEEM) e Mini Exame Cognitivo de Addenbrooke (M-ACE). Os participantes obtiveram um bom desempenho na avaliação global da cognição pelo MEEM, com média de 24,9 (±2,89). Observando-se a média (24,91 ± 2,89) do MEEM, nota-se que os participantes apresentam bom desempenho cognitivo, de acordo com a avaliação global da cognição. Os resultados apontam ainda que estudar 9 anos ou mais, ter mais de 50 livros na infância, participar de eventos culturais, dirigir, realizar trabalho voluntário, participar de diretorias, ler, acessar o e-mail e a internet foram significativamente associadas ao bom desempenho cognitivo. Conclui-se que o MEEM se associou com participação em eventos culturais, dirigir, realizar trabalho voluntário, participar de diretorias e ler após ajuste com variáveis gênero, faixa etária e escolaridade / One of the challenges for gerontological research front of cognitive reserve is how to maintain and promote cognitive functioning preserved in old age. Currently, studies on cognition, aging and old age have progressed significantly. The first article with the objective of verifying different profiles of cognitive gain in the elderly for the cognitive reserve presents data from a scoping review in order to evaluate the cognitive reserve and the different effects of the interventions performed. A study was carried out between January 2008 and August 2018 in the PubMed, Medline, Web of Science, Science Direct, Lilacs, SciELO, PsycInfo, PsycNet and AgeLine databases using the following keywords \"cognitive reserve\" and {aging or \"old age\" or \"old people\" or \"elderly adults\"} and the terms \"cognitive reserve\" AND {aging OR \"old age\" OR \"old people\" OR \"old adults\"}. We identified 2295 studies, 51 were eligible for scoping review. Within the 51 selected studies, 9 different profiles were found for cognitive maintenance, and 5 studies did not specify the profile. The profiles found represent relevance to the theory of cognitive reserve and provides insights into how individual and daily life factors can make the brain more resilient in aging and old age, but how individual factors contribute to the development of CR and maintenance of cognition, is an issue not yet explained in the literature. The second article on the design of an empirical research evaluates the association between cognition and advanced activities of daily living in a sample of Brazilian elderly people living in the community as a way to contribute to the understanding of these profiles for improvements in their cognitive abilities. This was a cross-sectional analysis of 271 elderly people, aged 80 years and over, who participated in a follow-up phase (2016-2017) of a community-based study called FIBRA. The first phase of data collection occurred between 2008 and 2009. In the follow-up study, the households of participants from two sites, Campinas and Ermelino Matarazzo, were revisited and new data were collected from those who agreed to participate in this phase. Participants completed a block of measures that included sociodemographic information, cognitive tests Mini-Mental State Examination (MMSE) and Addenbrooke\'s Mini Cognitive Examination (M-ACE). Participants performed well in the overall evaluation of cognition by the MMSE, with an average of 24.9 (± 2.89). Observing the mean (24.91 ± 2.89) of the MMSE, it is observed that the participants present good cognitive performance, according to the global assessment of cognition. The results also point out that studying 9 years or more, having more than 50 books in childhood, participating in cultural events, directing, volunteering, attending boardrooms, reading, accessing e-mail and the Internet were significantly associated with good performance cognitive. It was concluded that the MMSE was associated with participation in cultural events, direct, volunteer work, participate in boards and read after adjustment with variables gender, age group and schooling

Background: Good social connections have been identified as a factor that may be associated with healthy cognitive function in later life. In line with cognitive reserve theory, good social connections may provide mental stimulation through complex interaction with others and hence build cognitive reserve and maintain healthy cognitive function. However, there is considerable inconsistency in findings reported by studies that examine this association. Inconsistency in findings may be attributed to the heterogeneity of concepts potentially associated with social connections and to the variation in approaches to measuring and defining these concepts. Aims: To assess the association between aspects of social connections and cognitive function in later life. This thesis introduces a novel element by considering the moderating role of cognitive reserve in this association. Method: A scoping review was conducted to establish which concepts are used within the literature to describe social connections and how these are measured and defined. Next, a systematic review and meta-analysis was conducted to identify evidence regarding the association between social isolation and cognitive function in published studies. Empirical work was conducted using cross-sectional and longitudinal data from the Cognitive Function and Ageing Study-Wales (CFAS-Wales) to determine the associations between social isolation, cognitive reserve, and cognitive function in healthy older people. Extending this approach further, these associations were examined in two groups potentially at risk of social isolation: older people with depression or anxiety and older people living alone. Finally, empirical work was completed using the Platform for Research Online to investigate Genetics and Cognition in Ageing (PROTECT) to assess how satisfaction with social contact may be associated with cognitive function compared to a structural measure of isolation. Results: A lack of social connections was associated with poor cognitive function in later life. For people with depression or anxiety, these associations may be better explained by mood-related symptoms than social connections. People who live alone in later life were at no greater risk of poor cognitive function compared to those living with others. Satisfaction with social contact was associated with poor cognitive function but a structural measure of social isolation was not. Conclusions: Social connections play an important role in building cognitive reserve and protecting people against poor cognitive function in later life. People who are vulnerable to social isolation have different needs to those who are less vulnerable. Satisfaction with social contact is often neglected in measures that assess structural aspects of social connections but may be a better predictor of cognitive function.

Older bilingual adults typically perform better than monolinguals in tasks of executive control, and are diagnosed later with dementia. Studies have also shown structural and functional brain differences between bilinguals and monolinguals. However, it remains poorly understood how language history influences the functional organization of the aging brain. The current study investigated; 1) differences in resting-state functional connectivity between monolinguals and bilinguals in the Default Mode Network (DMN), Frontoparietal Network (FPN), Executive Control Network (ECN), Language Network (LANG), and a network consisting of structures associated with tasks of executive control coined the Bilingual Control Network (BCN); 2) the relationship of cognitive performance with functional connectivity of the BCN; and 3) whether proficiency, age of second language acquisition, degree of second language exposure, and frequency of language use predicts the network’s functional connectivity. Healthy older bilinguals (N=10) were matched pairwise for age, sex and education to healthy older monolinguals (N=10). All participants completed a battery of cognitive tests, a language history questionnaire, and a 6-minute functional scan during rest. Results showed that groups did not differ in cognitive performance, or in the functional connectivity of the FPN, ECN, LANG, or BCN. However, monolinguals had significantly stronger functional connectivity in the DMN compared to bilinguals. Later age of second language acquisition and lower proficiency were also associated with greater DMN functional connectivity. None of these variables predicted BCN’s functional connectivity. However, bilinguals showed stronger functional connectivity with other structures outside of the canonical networks compared to monolinguals. Finally, vocabulary scores, local switch cost accuracy and reaction time were negatively correlated with BCN’s functional connectivity. Overall, these findings illustrate differences in functional brain organization associated with language experience in the DMN, while challenging the “bilingual advantage” hypothesis. The results also suggest a possible neural mechanism by which bilingualism might mediate cognitive reserve.

A small subset of individuals that have experienced mild traumatic brain injury (mTBI) may experience persistent cognitive deficits more than a year following the head injury. Neuroimaging studies reveal structural and functional changes in frontal areas of the brain, exacerbated when loss of consciousness is experienced, and indicate that these changes may be progressive in nature for some people. Social support and social participation have, however, been suggested to confer cognitive reserve - neurocognitive protection against cognitive decline. Analyses were run on Canadian Longitudinal Study on Aging (CLSA) neuropsychological data, consisting of individuals who experienced mTBI with loss of consciousness (n = 536 for less than 1 minute, and n = 435 for unconsciousness between 1 and 20 minutes) more than a year prior, and 13,163 no-head injury comparisons. These same individuals were re-assessed three years later. The results presented in this thesis suggest that at a year or more after a single mTBI with loss of consciousness, a small subset of individuals are more likely to be impaired on prospective memory and other executive functioning tasks, relative to comparisons. In addition, when examined at three-year follow-up, those who experienced mTBI with longer duration of unconsciousness were more likely to exhibit cognitive decline relative to those who experienced less unconsciousness or comparisons. Moreover, greater social participation over the past year, and more perceived social support were predictive of lessened cognitive deterioration in those individuals.

This research involves an examination of the relationship between education and age on a wide array of neuropsychological test measures among patients diagnosed with Alzheimer's and vascular dementia. The purpose of this study was to investigate the role of education as an attenuating factor to neurocognitive decline in dementia. Although numerous studies have been published regarding the relationship between educational attainment and AD, few have included other subtypes of dementia in their investigation. To further expand the generalizability of previous findings, the sample in this study included both AD and VaD. While previous research has demonstrated a relationship between education and age-related neurocognitive decline in AD, most studies have utilized the MMSE or brief screening instrument to assess cognitive functioning. The present research included VaD and examined a variety of cognitive domains such as measures of global functioning, verbal intelligence, verbal memory, visual memory, attention/concentration, language, visuospatial skills, speed-of-processing, and abstract reasoning/executive functioning. Two standard multiple regression analyses were conducted, the first including age and education as the independent variables to assess the effects on one over and above that of the other. The second analysis included age, education, and their interaction term in order to determine if education attenuates age-related neurocognitive decline in the diagnostic groups. Raw neuropsychological test measure scores were included in all analyses as dependent measures. Results revealed that age minimally predicted performance in both groups, whereas education better predicted neurocognitive test performance in the AD group than in the VaD group. Furthermore, findings suggest that among individuals with AD, the rate of neurocognitive impairment in encoding verbal information and visuoconstructional ability is buffered by higher levels of education attainment. None of the interaction terms were significant for the VaD group. The current findings question the extent and generalizability of the presumed protective effects of higher education on age-related neurocognitive decline.

Background: Cognitive reserve (CR) has been associated with better cognitive function and lower risk of dementia in older people, yet it remains unclear whether sex moderates the association between CR and cognition. This study aims to identify whether sex influences both the relationships between brain-cognition and how CR proxies moderate the brain-cognition relationship. Materials and Methods: Complete data on the measures of CR, education, occupation, and cognition were available for 189 healthy individuals aged 60 to 71 years (105 men and 84 women). Multiple linear regression models were used to investigate the potential effect of sex and CR proxies on the association between the brain and cognition measures. Results: The results highlighted differences in speed/attention for males compared to females at high education and high occupational complexity. No significant sex differences in brain measures were observed in meanPutamen, meanCaudate, and meanHippocampal volume. Conclusion/Significance: Traditional reserve contributors are influenced by gender and may be a result of different social determinants among men and women. Both sex-specific risk and protective factors for cognitive decline trajectories are critical for advancing knowledge for individualized interventions.

A Doença de Parkinson (DP) é uma das doenças degenerativas do Sistema Nervoso Central que mais acomete indivíduos no mundo. Apesar de a DP ser descrita classicamente como desordem do movimento, sintomas não motores também fazem parte da apresentação da doença, como as alterações cognitivas, que podem estar presentes antes mesmo de os sintomas motores serem percebidos. Os principais domínios cognitivos afetados na DP são as funções executivas (FE). Estas consistem num contingente de funções de ordem superior, que são cruciais para cognição, emoção e comportamento. Muitos estudos abordam a influência das FE no controle da marcha, já que esta não é mais considerada como um ato motor puramente automático. De fato, existem componentes cognitivos na generalização e manutenção de um padrão de marcha consistente e normal, o que justifica os prejuízos neste controle interdependente entre FE e marcha na DP. O objetivo deste estudo foi avaliar a eficiência de um treino original de marcha com demandas motoras e cognitivas desafiadoras, integradas em um contexto funcional em pacientes com DP em estágio inicial. Trata-se de um ensaio clínico cego e randomizado realizado na Associação Brasil Parkinson em São Paulo. Participaram do estudo 25 pacientes com DP nos estágios 1 a 2,5 da escala Hoehn & Yahr. Eles foram distribuídos aleatoriamente nos grupos experimental (GE: 13 sujeitos) e controle (GC: 12 sujeitos). Os dois grupos foram submetidos a 10 sessões de treinamento, com duração de 60 minutos cada uma (divididos em 25 minutos de exercícios de mobilidade global e 35 minutos para os treinos específicos), com frequência de duas vezes por semana, por 5 semanas. O treino experimental consistiu em treino de marcha com demandas motoras desafiadoras e demandas cognitivas constituídas por seis tarefas que exigiam as principais FE envolvidas na realização da marcha, que foram integradas em um contexto funcional. O treino 12 controle consistiu apenas de demandas motoras desafiadoras. As principais medidas foram: (1) Dynamic Gait Index (DGI); (2) Montreal Cognitive Assessment (MoCA); (3) teste de marcha em 30 segundos em dupla-tarefa cognitiva; (4) sessão II da Escala Unificada da Doença de Parkinson (UPDRS). Anova de medidas repetidas seguida de teste de Tukey avaliou a existência de diferenças dentro de cada grupo, em avaliações realizadas antes (AT), depois (DT) e após 60 dias do final do treinamento (RET). Resultados mostraram melhora estatisticamente significativa no DGI, MoCA, teste de marcha em dupla tarefa cognitiva, e sessão II da UPDRS. Entretanto, na medida de seguimento após 60 dias, para várias medidas foram observadas diferentes tendências entre os grupos: o GE apresentou uma tendência à manutenção dos ganhos, ao passo que o GC apresentou uma tendência à remissão dos ganhos. Conclui-se que os pacientes com DP lograram melhoras nos âmbitos motor, cognitivo e funcional por meio de um treinamento baseado na associação de tarefas cognitivas à marcha dentro de um contexto funcional, ganhos estes possivelmente mais estáveis em comparação aos oriundos do treino motor isolado / Parkinson\'s disease (PD) is one of the most frequent degenerative diseases of the central nervous system. Despite being classically described as a motor disorder, non-motor symptoms such as cognitive disorders are also part of the disease, and may be present even before patients become aware of their motor disorders. The main cognitive domains that are affected in PD are executive functions (EF). They consist of a number of higher-order functions, which are crucial for cognition, emotion and behavior. Several studies address influence of EF upon gait control, since gait is no longer considered as a purely automatic motor act. In fact, there are cognitive components in the generalization and maintenance of a normal consistent gait pattern. This helps explain why damages in EF affect gait control in PD, and gait affects EF. The study aimed to assess the effectiveness of an original gait training with challenging motor and cognitive demands, which are integrated in a functional context in patients with early PD. It consists of a blind randomized clinical trial, which was conducted at the Brazil Parkinson\'s Association in Sao Paulo. In the procedure 25 patients, with PD in stages 1 to 2.5 on Hoehn & Yahr scale, were randomly assigned to experimental group (13 subjects) and control group (12 subjects). Training consisted of 10 sessions, 60 minutes each. Sessions were divided into global mobility exercises (25 minutes) and training (35 minutes). Sessions occurred twice a week over five weeks. Experimental training consisted of a gait training with challenging motor demands and cognitive demands. There were six tasks that demanded important EF involved in gait performance, which were integrated into a functional context. Control training consisted only of challenging motor demands. Measures included: (1) Dynamic Gait Index (DGI); (2) Montreal Cognitive Assessment (MoCA); (3) gait test for 30 seconds in dual-cognitive task; (4) session II of the Unified Parkinsons Disease Rating Scale (UPDRS). Repeated measures ANOVA followed by Tukey tests were used to assess the existence of differences 14 within each group, in measures taken before training, after training, and in a follow-up 60 days after training. Both groups showed improvement in DGI, MoCA, gait test in dual-cognitive task, and session II of the UPDRS. However, in the follow-up assessment 60 days after training different trends were observed between the groups: EG showed a tendency to maintain gains, whereas CG showed a tendency to remission of gains. In conclusion, PD patients showed improvements in motor, cognitive and functional areas through a combination of a training based on challenging cognitive tasks on gait integrated in a functional context. Such gains were possibly more stable than those derived from gait training alone