The importance of cognitive reserve in comprehensive geriatric assessment for dementia
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The importance of cognitive reserve in comprehensive geriatric assessment for dementia Maria Devita1 · Sara Mondini2 · Alessandra Bordignon1 · Giuseppe Sergi1 · Agostino Girardi1 · Enzo Manzato1 · Daniela Mapelli2 · Alessandra Coin1 Received: 21 February 2019 / Accepted: 19 July 2019 © Springer Nature Switzerland AG 2019
Keywords Cognitive reserve · Comprehensive geriatric assessment · Dementia · Diagnosis · Cognitive stimulation
Introduction The role cognitive reserve (CR) plays in modulating the onset and evolution of dementia has been investigated and can now be considered well founded. There is evidence that different levels of CR can impact the diagnosis and treatment of dementia-related disorders [1]. The CR hypothesis proposes that the brain actively copes with damage using pre-existing cognitive processes or compensatory strategies. Accordingly, people with a high CR can tolerate more age-related alterations and disease-related pathologies by effectively and flexibly using compensatory cognitive and brain networks. Proximate and remote anamnesis, potential comorbidities, nutritional, physical and functional status, cognition, affectivity and social resources are generally explored during the most common diagnostic processes, such as the comprehensive geriatric assessment (CGA) [2]. Conversely, a formal measure of CR in clinical practice is still largely neglected, although it may add valuable information to enrich the clinical approach to persons with dementia. As a matter of fact, knowing the level of CR can help clinicians to consider that the observed cognitive profile is potentially the “outward appearance” of an ongoing degenerative process compensated by CR [1]. This means that even the most recognized and commonly used psychometric measures can fail in early detection of cognitive impairments, such as the Mini-Mental
State Examination (MMSE). The MMSE has been widely acknowledged as the most commonly used screening test to evaluate a decline in cognition. However, and as mentioned above, in light of the protective role played by CR, performance at MMSE may be poorly informative, if not misleading. In daily clinical practice, it is frequent to assess patients who display no congruence among MMSE scores, underlying neuroanatomical damage and complaining of cognitive and/or behavioral symptoms of dementia. According to the CR theory, patients with lower CR scores on MMSE may be considered reliable or, at least, representative of both cognitive and neuroanatomical status. Conversely, patients with higher CR scores on MMSE could mask the actual cognitive and neuroanatomical status, so particular attention must be paid, and specific, more sensitive neuropsychological diagnostic tools should be used. When properly measured, CR helps to assess cognitive performance in relation to brain resilience to neuropathological damage. The difference between adequate cognitive performance, despite underlying brain pathology, may so be explicable in terms of CR that, therefore, should be considered
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