The Influence of Birth Cohorts on Future Cognitive Decline.

Abstract

Slowed rates of cognitive decline have been reported in individuals with higher cognitive reserve (CR), but interindividual discrepancies remain unexplained. Few studies have reported a birth cohort effect, favoring later-born individuals, but these studies remain scarce. We aimed to predict cognitive decline in older adults using birth cohorts and CR. Within the Alzheimer's Disease Neuroimaging Initiative, 1,041 dementia-free participants were assessed on four cognitive domains (verbal episodic memory; language and semantic memory; attention; executive functions) at each follow-up visit up to 14 years. Four birth cohorts were formed according to the major historical events of the 20th century (1916-1928; 1929-1938; 1939-1945; 1946-1962). CR was operationalized by merging education, complexity of occupation, and verbal IQ. We used linear mixed-effect models to evaluate the effects of CR and birth cohorts on rate of performance change over time. Age at baseline, baseline structural brain health (total brain and total white matter hyperintensities volumes), and baseline vascular risk factors burden were used as covariates. CR was only associated with slower decline in verbal episodic memory. However, more recent birth cohorts predicted slower annual cognitive decline in all domains, except for executive functions. This effect increased as the birth cohort became more recent. We found that both CR and birth cohorts influence future cognitive decline, which has strong public policy implications.