Resilience and MRI correlates of cognitive impairment in community-dwelling elders.
BACKGROUND
The contribution of education and intelligence to resilience against age-related cognitive decline is not clear, particularly in the presence of 'normal for age' minor brain abnormalities.


METHODS
Participants (n = 208, mean age 69.2 years, s.d. = 5.4) in the Whitehall II imaging substudy attended for neuropsychological testing and multisequence 3T brain magnetic resonance imaging. Images were independently rated by three trained clinicians for global and hippocampal atrophy, periventricular and deep white matter changes.


RESULTS
Although none of the participants qualified for a clinical diagnosis of dementia, a screen for cognitive impairment (Montreal Cognitive Assessment (MoCA) <26) was abnormal in 22%. Hippocampal atrophy, in contrast to other brain measures, was associated with a reduced MoCA score even after controlling for age, gender, socioeconomic status, years of education and premorbid IQ. Premorbid IQ and socioeconomic status were associated with resilience in the presence of hippocampal atrophy.


CONCLUSIONS
Independent contributions from a priori risk (age, hippocampal atrophy) and resilience (premorbid function, socioeconomic status) combine to predict measured cognitive impairment.
Anya Topiwala, BMBCh, Charlotte L. Allan, MBChB, Vyara Valkanova, MD, Enikő Zsoldos, MSc, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Nicola Filippini, DPhil, Claire E. Sexton, DPhil, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK and Oxford Centre for Functional MRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Abda Mahmood, MSc, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Archana Singh-Manoux, PhD, Department of Epidemiology and Public Health, UCL, London, UK and INSERM, U1018, Centre for Research in Epidemiology and Population Health, France; Clare E. Mackay, PhD, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Mika Kivimäki, PhD, Department of Epidemiology and Public Health, UCL, London, UK; Klaus P. Ebmeier, MD, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
Anya
A
Topiwala
Anya Topiwala, BMBCh, Charlotte L. Allan, MBChB, Vyara Valkanova, MD, Enikő Zsoldos, MSc, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Nicola Filippini, DPhil, Claire E. Sexton, DPhil, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK and Oxford Centre for Functional MRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Abda Mahmood, MSc, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Archana Singh-Manoux, PhD, Department of Epidemiology and Public Health, UCL, London, UK and INSERM, U1018, Centre for Research in Epidemiology and Population Health, France; Clare E. Mackay, PhD, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Mika Kivimäki, PhD, Department of Epidemiology and Public Health, UCL, London, UK; Klaus P. Ebmeier, MD, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
Charlotte L
CL
Allan
Anya Topiwala, BMBCh, Charlotte L. Allan, MBChB, Vyara Valkanova, MD, Enikő Zsoldos, MSc, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Nicola Filippini, DPhil, Claire E. Sexton, DPhil, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK and Oxford Centre for Functional MRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Abda Mahmood, MSc, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Archana Singh-Manoux, PhD, Department of Epidemiology and Public Health, UCL, London, UK and INSERM, U1018, Centre for Research in Epidemiology and Population Health, France; Clare E. Mackay, PhD, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Mika Kivimäki, PhD, Department of Epidemiology and Public Health, UCL, London, UK; Klaus P. Ebmeier, MD, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
Vyara
V
Valkanova
Anya Topiwala, BMBCh, Charlotte L. Allan, MBChB, Vyara Valkanova, MD, Enikő Zsoldos, MSc, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Nicola Filippini, DPhil, Claire E. Sexton, DPhil, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK and Oxford Centre for Functional MRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Abda Mahmood, MSc, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Archana Singh-Manoux, PhD, Department of Epidemiology and Public Health, UCL, London, UK and INSERM, U1018, Centre for Research in Epidemiology and Population Health, France; Clare E. Mackay, PhD, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Mika Kivimäki, PhD, Department of Epidemiology and Public Health, UCL, London, UK; Klaus P. Ebmeier, MD, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
Enikő
E
Zsoldos
Anya Topiwala, BMBCh, Charlotte L. Allan, MBChB, Vyara Valkanova, MD, Enikő Zsoldos, MSc, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Nicola Filippini, DPhil, Claire E. Sexton, DPhil, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK and Oxford Centre for Functional MRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Abda Mahmood, MSc, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Archana Singh-Manoux, PhD, Department of Epidemiology and Public Health, UCL, London, UK and INSERM, U1018, Centre for Research in Epidemiology and Population Health, France; Clare E. Mackay, PhD, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Mika Kivimäki, PhD, Department of Epidemiology and Public Health, UCL, London, UK; Klaus P. Ebmeier, MD, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
Nicola
N
Filippini
Anya Topiwala, BMBCh, Charlotte L. Allan, MBChB, Vyara Valkanova, MD, Enikő Zsoldos, MSc, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Nicola Filippini, DPhil, Claire E. Sexton, DPhil, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK and Oxford Centre for Functional MRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Abda Mahmood, MSc, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Archana Singh-Manoux, PhD, Department of Epidemiology and Public Health, UCL, London, UK and INSERM, U1018, Centre for Research in Epidemiology and Population Health, France; Clare E. Mackay, PhD, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Mika Kivimäki, PhD, Department of Epidemiology and Public Health, UCL, London, UK; Klaus P. Ebmeier, MD, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
Claire E
CE
Sexton
Anya Topiwala, BMBCh, Charlotte L. Allan, MBChB, Vyara Valkanova, MD, Enikő Zsoldos, MSc, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Nicola Filippini, DPhil, Claire E. Sexton, DPhil, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK and Oxford Centre for Functional MRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Abda Mahmood, MSc, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Archana Singh-Manoux, PhD, Department of Epidemiology and Public Health, UCL, London, UK and INSERM, U1018, Centre for Research in Epidemiology and Population Health, France; Clare E. Mackay, PhD, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Mika Kivimäki, PhD, Department of Epidemiology and Public Health, UCL, London, UK; Klaus P. Ebmeier, MD, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
Abda
A
Mahmood
Anya Topiwala, BMBCh, Charlotte L. Allan, MBChB, Vyara Valkanova, MD, Enikő Zsoldos, MSc, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Nicola Filippini, DPhil, Claire E. Sexton, DPhil, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK and Oxford Centre for Functional MRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Abda Mahmood, MSc, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Archana Singh-Manoux, PhD, Department of Epidemiology and Public Health, UCL, London, UK and INSERM, U1018, Centre for Research in Epidemiology and Population Health, France; Clare E. Mackay, PhD, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Mika Kivimäki, PhD, Department of Epidemiology and Public Health, UCL, London, UK; Klaus P. Ebmeier, MD, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
Archana
A
Singh-Manoux
Anya Topiwala, BMBCh, Charlotte L. Allan, MBChB, Vyara Valkanova, MD, Enikő Zsoldos, MSc, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Nicola Filippini, DPhil, Claire E. Sexton, DPhil, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK and Oxford Centre for Functional MRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Abda Mahmood, MSc, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Archana Singh-Manoux, PhD, Department of Epidemiology and Public Health, UCL, London, UK and INSERM, U1018, Centre for Research in Epidemiology and Population Health, France; Clare E. Mackay, PhD, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Mika Kivimäki, PhD, Department of Epidemiology and Public Health, UCL, London, UK; Klaus P. Ebmeier, MD, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
Clare E
CE
Mackay
Anya Topiwala, BMBCh, Charlotte L. Allan, MBChB, Vyara Valkanova, MD, Enikő Zsoldos, MSc, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Nicola Filippini, DPhil, Claire E. Sexton, DPhil, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK and Oxford Centre for Functional MRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Abda Mahmood, MSc, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Archana Singh-Manoux, PhD, Department of Epidemiology and Public Health, UCL, London, UK and INSERM, U1018, Centre for Research in Epidemiology and Population Health, France; Clare E. Mackay, PhD, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Mika Kivimäki, PhD, Department of Epidemiology and Public Health, UCL, London, UK; Klaus P. Ebmeier, MD, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
Mika
M
Kivimäki
Anya Topiwala, BMBCh, Charlotte L. Allan, MBChB, Vyara Valkanova, MD, Enikő Zsoldos, MSc, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Nicola Filippini, DPhil, Claire E. Sexton, DPhil, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK and Oxford Centre for Functional MRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Abda Mahmood, MSc, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Archana Singh-Manoux, PhD, Department of Epidemiology and Public Health, UCL, London, UK and INSERM, U1018, Centre for Research in Epidemiology and Population Health, France; Clare E. Mackay, PhD, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Mika Kivimäki, PhD, Department of Epidemiology and Public Health, UCL, London, UK; Klaus P. Ebmeier, MD, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK klaus.ebmeier@psych.ox.ac.uk.
Klaus P
KP
Ebmeier
D000368:Aged; D001284:Atrophy / Q000473:pathology; D003072:Cognition Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D006624:Hippocampus / Q000473:pathology*; D006801:Humans; D016015:Logistic Models; D008131:London; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D055500:Resilience, Psychological