Cognitive functioning, cognitive reserve, and residential care placement in patients with Alzheimer's and related dementias.
OBJECTIVE
To test the hypothesis that patients with mild to moderate dementia with higher initial cognitive reserve (higher education levels exhibit faster cognitive decline at later stages of disease progression as they approach residential care (RC) placement.


METHODS
Two provincial administrative databases were used. One contained individuals' scores of cognitive functioning (assessed at 6- to 12-month intervals using the Standardized Mini-Mental State Examination, SMMSE, 2007-2014) and education level; the second (BC Ministry of Health Home and Community Care database, 2001-2014) contained individuals' RC placement; N = 10531.


RESULTS
During 2.5-0.5 years prior to placement, SMMSE scores of patients with 0-8 years of education dropped slightly (M D 20.6 to 20.0), while patients with 9-12 years and 13+ years of education started higher (M D 21.8 and 21.4), but decreased faster and ended up lower (M D 19.5 and 18.8). Six-months prior to placement, SMMSE scores of all groups dropped almost 2 points.


CONCLUSIONS
Once cognitive reserve of more highly educated dementia patients is depleted and they approach RC placement, their cognitive functioning deteriorates faster. Finding effective interventions that maintain or enhance cognitive reserve may increase the time in the community for dementia patients.
a Centre on Aging , University of Victoria , Victoria , BC , Canada.
Helena
H
Kadlec
a Centre on Aging , University of Victoria , Victoria , BC , Canada.
Carren
C
Dujela
b Clinic for Alzheimer Disease and Related Disorders , University of British Columbia , Vancouver , BC , Canada.
B Lynn
BL
Beattie
a Centre on Aging , University of Victoria , Victoria , BC , Canada.|c Department of Sociology , University of Victoria , Victoria , BC , Canada.
Neena
N
Chappell
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis / Q000503:physiopathology; D001955:British Columbia; D058245:Cognitive Reserve / Q000502:physiology*; D016208:Databases, Factual; D003704:Dementia / Q000175:diagnosis / Q000503:physiopathology*; D018450:Disease Progression; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D000073216:Mental Status and Dementia Tests / Q000706:statistics & numerical data*; D012112:Residential Facilities / Q000706:statistics & numerical data*
Alzheimer's disease; Alzheimer's disease and related dementias; Cognitive reserve; residential care