Mediatory effect of depression in the relations between cognitive reserve and cognitive abilities. Does a CR index matter?
Słowa kluczowe:
cognitive reserve, cognitive functioning, depression, adultsAbstrakt
Background
Cognitive reserve (CR) explains the level of cognitive functioning in healthy aging individuals or those with brain dysfunctions. Various CR indexes include objective (e.g. education level), subjective (e.g. self-report methods of life activity), and their combinations. Data showing the impact of CR on cognitive performance are unclear due to the relationship between CR and depressive mood as well as due to the impact of depressed mood on cognitive functions. The current study was designed to determine the link between three different CR indicators and cognitive abilities of adult Poles. The analyses took into account intensity of depression, as a mediator for these links. Additionally, the study was designed to assess whether or not the contents of the self-reported part of the CR index were of significance for the relations.
Participants and procedure
The study was carried out in two unrelated groups of adult Poles (Group I, n = 130; Group II, n = 90). Assessment of CR took into account three indexes (CR based on self-reported activity in life, CR additionally containing information on formal education, and CR supplemented with information related to occupational activity). Cognitive capacity was assessed using the Montreal Cognitive Assessment Scale (MoCA), Vocabulary, as well as Digit Span Forward and Backwards. Intensity of depression was measured using
Beck Depression Inventory (BDI) II. The self-report part of the questionnaire used to measure CR in Group I contained items mainly about past life and in Group II consisted of more items about both past life and current activity.
Results
The greater CR corresponds to higher scores in cognitive tasks and lower intensity of depressive mood. This is in line with previous research reporting that a higher level of the reserve may protect against mood disorders. Depression mediates the links between CR and the cognitive functions, reducing the positive impact of CR. These relations were visible in Group I, where CR based on self-reported activity in life comprised items about (mainly) past life.
Conclusions
Self-report techniques used in CR assessment may be inadequate as a tool for describing the reserve, due to the link between self-report and emotional state. However, a more detailed self-report component of the CR indicator about both past and current life may correspond to a weaker or insignificant relation between CR and depressive mood as well as between depression and cognitive capacities. Varied approaches to operationalisation of CR result in discrepancies regarding the role of resources in the stabilisation and dynamics of cognitive status in ageing people and in clinical groups.
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Bibliografia
Adam, S., Bonsang, E., Grotz, C., & Perelman, S. (2013). Occupational activity and cognitive reserve: implications in terms of prevention of cognitive aging and Alzheimer's disease. Clinical Interventions in Aging, 8, 377–390. https://doi.org/10.2147/CIA.S39921
Alladi, S., Bak, T., Duggirala, V., Surampudi, B., Shailaja, M., Shukla, A., & Kaul, S. (2013). Bilingualism delays age at onset of dementia, independent of education and immigration status. Neurology, 81, 1938–1944. https://doi.org/10.1212/01.wnl.0000436620.33155.a4
Altschuler, A., Picchi, T., Nelson, M., Rogers, J., Hart, J., & Sternfeld, B. (2009). Physical activity questionnaire comprehension: lessons from cognitive interviews. Medicine and science in sports and exercise, 41, 336–343. https://doi.org/
Amer, M., El Akkad, R., & Hassan, H. (2014). Is cognition a determinant of health related quality of life in community dwelling non demented elderly? Advances in Aging Research, 3, 339–348. https://doi.org/10.4236/aar.2014.35044
Atkinson, M., Zibin, S., & Chuang, H. (1997). Characterizing quality of life among patients with chronic mental illness: a critical examination of the self-report methodology. American Journal of Psychiatry, 154, 99–105. https://doi.org/10.1176/ajp.154.1.99
Beck, A. T., Steer, R., & Brown, G. (1996). Manual for the Beck Depression Inventory II. San Antonio, TX: Psychological Corporation.
Beck, A. T., Steer, R., & Brown, G. (2019). BDI-II. Podręcznik [BDI-II. Manual]. Warszawa: Pracownia Testów Psychologicznych Polskiego Towarzystwa Psychologicznego.
Bialystok, E., Craik, F., & Freedman, M. (2007). Bilingualism as a protection against the onset of symptoms of dementia. Neuropsychologia, 45, 459–464. https://doi.org/10.1016/j.neuropsychologia.2006.10.009
Bravell, M., Zarit, S., & Johansson, B. (2011). Self-reported activities of daily living and performance based functional ability: a study of congruence among the oldest old. European Journal of Ageing, 8, 199–209. https://doi.org/10.1007/s10433-011-0192-6
Brzeziński, J., Gaul, M., Hornowska, E., Jaworowska, A., Machowski, A., & Zakrzewska, M. (2004). Skala Inteligencji D. Wechslera dla Dorosłych. Wersja zrewidowana – renormalizacja WAIS-R (PL) [D. Wechsler Intelligence Scale for Adults. Revised version – renormalization WAIS-R (PL)]. Warszawa: Pracownia Testów Psychologicznych Polskiego Towarzystwa Psychologicznego.
Boots, E., Schultz, S., Almeida, R., Oh, J., Koscik, R., Dowling, M., Gallagher, C., Carlsson, C., Rowley, H., Bendlin, B., Asthana, S., Sager, M., Hermann, B., Johnson, S., & Okonkwo, O. (2015). Occupational complexity and cognitive reserve in a middle-aged cohort at risk for Alzheimer’s disease. Archives of Clinical Neuropsychology, 30, 634–642. https://doi.org/10.1093/arclin/acv041
Calvo, N., García, A., Manoiloff, L., & Ibáñez, A. (2016). Bilingualism and cognitive reserve: a critical overview and a plea for methodological innovations. Frontiers in Aging Neuroscience, 7, 249. https://doi.org/10.3389/fnagi.2015.00249.
Chan, D., Shafto, M., Kievit, R., Matthews, F., Spink, M., Valenzuela, M., Cam-CAN, & Henson, R. N. (2018). Lifestyle activities in mid-life contribute to cognitive reserve in late-life, independent of education, occupation, and late-life activities. Neurobiology of Aging, 70, 180 183. https://doi.org/10.1016/j.neurobiolaging.2018.06.012
Chapko, D., McCormack, R., Black, C., Staff, R., & Murray, A. (2018). Life-course determinants of cognitive reserve (CR) in cognitive aging and dementia – a systematic literature review. Aging & Mental Health, 22, 915–926. https://doi.org/10.1080/13607863.2017.1348471
Correa Ribeiro, P., Lopes, C., & Lourenço, R. (2013). Complexity of lifetime occupation and cognitive performance in old age. Occupational Medicine, 63, 556–562. https://doi.org/10.1093/occmed/kqt115
Cruz, B., de Resende, C., Carvalhaes, C., Cardoso, C., Teixeira, A., Rocha, F., & Salgado, J. (2016). Interview-based assessment of cognition is a strong predictor of quality of life in patients with schizophrenia and severe negative symptoms. Brazilian Journal of Psychiatry, 38, 216–221. https://doi. org/10.1590/1516-4446-2015-1776
Darby, R., Brickhouse, M., Wolk, D., Dickerson, B., & Alzheimer’s Disease Neuroimaging Initiative (2017). Effects of cognitive reserve depend on executive and semantic demands of the task. Journal of Neurology, Neurosurgery and Psychiatry, 88, 794–802. https://doi.org/10.1136/jnnp-2017-315719
Darwish, H., Farran, N., Assaad, S., & Chaaya, M. (2018). Cognitive reserve factors in a developing country: education and occupational attainment lower the risk of dementia in a sample of Leba nese older adults. Frontiers in Aging Neuroscience, 10, 277. https://doi.org/10.3389/fnagi.2018.00277
Dekhtyar, S., Wang, H. X., Scott, K., Goodman, A., Koupil, I., & Herlitz, A. (2015). A life-course study of cognitive reserve in dementia-from childhood to old age. The American Journal of Geriatric Psychiatry, 23, 885–896. https://doi.org/10.1016/j.jagp.2015.02.002
Domańska, Ł. (2011). Kliniczne zastosowanie Skali Inteligencji dla Dorosłych D. Wechslera w diagnozie neuropsychologicznej [Clinical application of D. Wechsler Adult Intelligence Scale in neuropsychological diagnosis]. In K. Wiejak & G. Krasowicz-Kupis (Eds.), Kliniczne zastosowania skal inteligencji D. Wechslera [Clinical applications of D. Wechsler’s intelligence scales] (pp. 126–136). Warszawa: Pracownia Testów Psychologicznych Polskiego Towarzystwa Psychologicznego.
Evans, I., Llewellyn, D., Matthews, F., Woods, R., Brayne, C., Clare, L., & CFAS-Wales Research Team (2018). Social isolation, cognitive reserve, and cognition in healthy older people. PLoS One, 13, e0201008. https://doi.org/10.1371/journal.pone.0201008
Farfel, J., Nitrini, R., Suemoto, C., Grinberg, L., Ferretti, R., Leite, R., Tampellini, E., Lima, L., Farias, D., Neves, R., Rodriguez, R., Menezes, P., Fregni, F., Bennett, D., Pasqualucci, C., Jacob-Filho, W., & Brazilian Aging Brain Study Group (2013). Very low levels of education and cognitive reserve: a clinicopathologic study. Neurology, 81, 650–657. https://doi.org/10.1212/WNL.0b013e3182a08f1b
Fox, M. T., Sidani, S., & Streiner, D. (2007). Using standardized survey items with older adults hospitalized for chronic illness. Research in Nursing & Health, 30, 468–481. https://doi.org/10.1002/nur.20201
Frank, L., Lenderking, W., Howard, K., & Cantillon, M. (2011). Patient self-report for evaluating mild cognitive impairment and prodromal Alzheimer’s disease. Alzheimer’s Research and Therapy, 3, 35. https://doi.org/10.1186/alzrt97
Frankenmolen, N., Fasotti, L., Kessels, R., & Oosterman, J. (2018). The influence of cognitive reserve and age on the use of memory strategies. Experimental Aging Research, 44, 117–134. https://doi.org/10.1080/0361073X.2017.1422472
Gerritsen, D., Steverink, N., Ooms, M., de Vet, H., & Ribbe, M. (2007). Measurement of overall quality of life in nursing homes through self-report: the role of cognitive impairment. Quality Life Research, 16, 1029–1037. https://doi.org/10.1007/s11136-0079203-7
Grotz, C., Seron, X., Wissen, M., & Adam, S. (2017). How should proxies of cognitive reserve be evaluated in a population of healthy older adults? International Psychogeriatrics, 29, 123–136. https://doi.org/10.1017/S1041610216001745
Guzmán-Vélezm, E., & Tranel, D. (2015). Does bilingualism contribute to cognitive reserve? Cognitive and neural perspectives. Neuropsychology, 29, 139–150. https://doi.org/10.1037/neu0000105
Hayes, A. (2017). Introduction to mediation, moderation, and conditional process analysis. Second edition: A regression-based approach. New York, NY: Guilford Press.
Jobe, J. (2009). Cognitive processes in self-report. In A. Stone, J. Turkkan, C. Bachrach, J. Jobe, H. Kurtzman, & V. Cain (Eds.), The science of self-report (pp. 25–29). Abingdon: Taylor & Francis.
Jones, R., Manly, J., Glymour, M., Rentz, D., Jefferson, A., & Stern, Y. (2011). Conceptual and measurement challenges in research on cognitive reserve. Journal of the International Neuropsychological Society, 17, 593–601. https://doi.org/10.1017/S1355617710001748
Katzman, R., Terry, R., DeTeresa, R., Brown, T., Davies, P., Fuld, P., Renbing, X., & Peck, A. (1988). Clinical, pathological, and neurochemical changes in dementia: a subgroup with preserved mental status and numerous neocortical plaques. Annals of Neurology, 23, 138–144. https://doi.org/10.1002/ana.410230206
Knäuper, B., Carriere, K., Chamandy, M., Xu, Z., Schwarz, N., & Rosen, N. (2016). How aging affects self-reports. European Journal of Ageing, 13, 185193. https://doi.org/10.1007/s10433-016-0369-0
Lavrencic, L., Churches, O., & Keage, H. (2018a). Cognitive reserve is not associated with improved performance in all cognitive domains. Applied Neuropsychology: Adult, 25, 473–485. https://doi.org/10.1080/23279095.2017.1329146
Lavrencic, L., Richardson, C., Harrison, S., Muniz-Terrera, G., Keage, H., Brittain, K., Kirkwood, T., Jagger, C., Robinson, L., & Stephan, B. (2018b). Is there a link between cognitive reserve and cognitive function in the oldest-old? The Journals of Gerontology: Series A, 73, 499–505. https://doi.org/10.1093/gerona/glx140
Le Carret, N., Lafont, S., Letenneur, L., Dartigues, J. F., Mayo, W., & Fabrigoule, C. (2003). The effect of education on cognitive performances and its implication for the constitution of the cognitive reserve. Developmental Neuropsychology, 23, 317337. https://doi.org/10.1207/S15326942DN2303_1
Lee, J., Park, H., & Chey, J. (2018). Education as a protective factor moderating the effect of depression on memory impairment in elderly women. Psychiatry Investigation, 15, 70–77. https://doi.org/10.4306/pi.2018.15.1.70
León, I., García-García, J., & Roldán-Tapia, L. (2014). Estimating cognitive reserve in healthy adults using the Cognitive Reserve Scale. PLoS One, 9, e102632. https://doi.org/10.1371/journal.pone.0102632
Logsdon, R., Gibbons, L., McCurry, S., & Teri, L. (2002). Assessing quality of life in older adults with cognitive impairment. Psychosomatic Medicine, 64, 510–519. https://doi.org/10.1097/00006842-200205000-00016
Lojo-Seoane, C., Facal, D., Guàrdia-Olmos, J., Pereiro, A., & Juncos-Rabadán, O. (2018). Effects of cognitive reserve on cognitive performance in a followup study in older adults with subjective cognitive complaints. the role of working memory. Frontiers in Aging Neuroscience, 10, 189. https://doi.org/10.3389/fnagi.2018.00189
Lukas, A., Niederecker, T., Günther, I., Mayer, B., & Nikolaus, T. (2013). Self- and proxy report for the assessment of pain in patients with and without cognitive impairment: experiences gained in a geriatric hospital. Zeitschrift für Gerontologie & Geriatrie, 46, 214–221. https://doi.org/10.1007/s00391013-0475-y
Malek-Ahmadi, M., Lu, S., Chan, Y., Perez, S., Chen, K., & Mufson, E. (2017). Static and dynamic cognitive reserve proxy measures: interactions with Alzheimer’s disease neuropathology and cognition. Journal of Alzheimer’s Disease and Parkinsonism, 7, 390. https://doi.org/10.4172/2161-0460.1000390
Marengoni, A., Fratiglioni, L., Bandinelli, S., & Ferrucci, L. (2011). Socioeconomic status during lifetime and cognitive impairment no-dementia in late life: the population-based aging in the Chianti Area (InCHIANTI) Study. Journal of Alzheimer’s Disease, 24, 559–568. https://doi.org/10.3233/JAD-2011-101863
Mazzeo, S., Padiglioni, S., Bagnoli, S., Bracco, L., Nacmias, B., Sorbi, S., & Bessi, V. (2019). The dual role of cognitive reserve in subjective cognitive decline and mild cognitive impairment: a 7-year follow-up study. Journal of Neurology, 266, 487497. https://doi.org/10.1007/s00415-018-9164-5
Mella, N., Grob, E., Döll, S., Ghisletta, P., & de Ribaupierre, A. (2017). Leisure activities and change in cognitive stability: a multivariate approach. Brain Sciences, 7, 27. https://doi.org/10.3390/brainsci7030027
Meng, X., & D’Arcy, C. (2012). Education and dementia in the context of the cognitive reserve hypothesis: a systematic review with meta-analyses and qualitative analyses. PLoS One, 7, e38268. https://doi.org/10.1371/journal.pone.0038268
Murman, D. (2015). The impact of age on cognition. Seminars in Hearing, 36, 111–121. https://doi. org/10.1055/s-0035-1555115
Murphy, M., & O’Leary, E. (2010). Depression, cognitive reserve and memory performance in older adults. International Journal of Geriatric Psychiatry, 25, 665–671. https://doi.org/10.1002/gps.2404
Nasreddine, Z., Phillips, N., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., Cummings, J., & Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. Journal of American Geriatric Society, 53, 695–699. https://doi.org/10.1111/j.1532-5415.2005.53221.x
Nucci, M., Mapelli, D., & Mondini, S. (2012). The Cognitive Reserve Index questionnaire (CRIq): A new instrument for measuring the cognitive reserve. Aging Clinical and Experimental Research, 24, 218226. https://doi.org/10.3275/7800
Opdebeeck, C., Quinn, C., Nelis, S., & Clare, L. (2015). Does cognitive reserve moderate the association between mood and cognition? A systematic review. Reviews in Clinical Gerontology, 25, 181–193. https://doi.org/10.1017/S0959259815000155
Opdebeeck, C., Martyr, A., & Clare, L. (2016) Cognitive reserve and cognitive function in healthy older people: a meta-analysis. Aging, Neuropsychology, and Cognition, 23, 40–60. https://doi.org/10.1080/13825585.2015.1041450
Pettigrew, C., Soldan, A., Li, S., Lu, Y., Wang, M. C., Selnes, O., Moghekar, A., O’Brien, R., Albert, M., & The Biocard Research Team (2013). Relationship of cognitive reserve and APOE status to the emergence of clinical symptoms in preclinical Alzheimer’s disease. Cognitive Neuroscience, 4, 136–142. https://doi.org/10.1080/17588928.2013.831820
Phillips, S., & Williams, J. (1997). Cognitive impairment, depression and the specificity of autobiographical memory in the elderly. British Journal of Clinical Psychology, 36, 341–347. https://doi. org/10.1111/j.2044-8260.1997.tb01242.x
Piolino, P., Desgranges, B., Benali, K., & Eustache, F. (2002). Episodic and semantic remote autobiographical memory in ageing. Memory, 10, 239–257. https://doi.org/10.1080/09658210143000353
Plassman, B., Welsh, K., Helms, M., Brandt, J., Page, W., & Breitner, J. (1995). Intelligence and education as predictors of cognitive state in late life: A 50-year follow-up. Neurology, 45, 1446–1450. https://doi.org/10.1212/wnl.45.8.1446
Prince, M., Acosta, D., Ferri, C., Guerra, M., Huang, Y., Rodriguez, J., Salas, A., Sosa, A., Williams, J., Dewey, M., Acosta, I., Jotheeswaran, A., & Liu, Z. (2012). Dementia incidence and mortality in middle-income countries, and associations with indicators of cognitive reserve: a 10/66 Dementia Research Group population-based cohort study. Lancet, 380, 50–58. https://doi.org/10.1016/S01406736(12)60399-7
Ramí, L., Valls-Pedret, C., Bartrés-Faz, D., Caprile, C., Solé-Padullés, C., Castellvi, M., Olives, J., Bosch, B., & Molinuevo, J. (2011). Cognitive reserve questionnaire. Scores obtained in a healthy elderly population and in one with Alzheimer’s disease. Revista de neurologia, 52, 195–201.
Richards, M., & Sacker, A. (2003). Lifetime antecedents of cognitive reserve. Journal of Clinical and Experimental Neuropsychology, 25, 614–624. https://doi.org/10.1076/jcen.25.5.614.14581
Roldán-Tapia, L., García, J., Cánovas, R., & León, I. (2012). Cognitive reserve, age, and their relation to attentional and executive functions. Applied Neuropsychology: Adult, 19, 2–8. https://doi.org/10.1080/09084282.2011.595458
Saenz, J., Garcia, M., & Downer, B. (2018). Late life depressive symptoms and cognitive function among older Mexican adults: the past and the present. Aging & Mental Health. https://doi.org/10.1080/13 607863.2018.1544214
Satz, P. (1993). Brain reserve capacity on symptom onset after brain injury: A formulation and review of evidence for threshold theory. Neuropsychology, 7, 273–295. https://doi.org/10.1037/08944105.7.3.273
Schwarz, N. (2006). Measurement: Aging and the Psychology of Self-Report. In L. Carstensen & C. Hartel (Eds.), When I’m 64 (pp. 219–230). Washington: The National Academic Press.
Singh-Manoux, A., Marmot, M., Glymour, M., Sabia, S., Kivimäki, M., & Dugravot, A. (2011). Does cognitive reserve shape cognitive decline? Annals of Neurology, 70, 296–304. https://doi.org/10.1002/ana.22391
Sivertsen, H., Bjørkløf, G., Engedal, K., Selbæk, G., & Helvik, A. (2015). Depression and quality of life in older persons: a review. Dementia and Geriatrics Cognitive Disorders, 40, 311–339. https://doi. org/10.1159/000437299
Smart, E., Gow, A., & Deary, I. (2014). Occupational complexity and lifetime cognitive abilities. Neurology, 83, 2285–2291. https://doi.org/10.1212/WNL.0000000000001075
Sobral, M., Pestana, M., & Paúl, C. (2014). Measures of cognitive reserve in Alzheimer’s disease. Trends in Psychiatry and Psychotherapy, 36, 160–168. https://doi.org/10.1590/2237-6089-2014-0012
Sokołowska, S., Sokołowski, R., Polak-Szabela, A., Mazur, E., Podhorecka, M., & Kędziora-Kornatowska, K. (2018). Comparison of the effectiveness of the Montreal Cognitive Assessment 7.2 and the Mini-Mental State Examination in the detection of mild neurocognitive disorder in people over 60 years of age. Preliminary study. Psychiatria Polska, 52, 843–857. https://doi.org/10.12740/PP/68611
Soldan, A., Pettigrew, C., Cai, Q., Wang, J., Wang, M., Moghekar, A., Miller, M., Albert, M., & the BIOCARD Research Team (2017). Cognitive reserve and long-term change in cognition in aging and preclinical Alzheimer’s disease. Neurobiology of Aging, 60, 164–172. https://doi.org/10.1016/j.neurobiolaging.2017.09.002
Stern, Y. (Ed.) (2007). Cognitive reserve – theory and applications. New York, NY: Taylor & Francis.
Šneidere, K., Montemurro, S., Mondini, S., Harlamova, J., Ulmane, Z., & Stepens, A. (2018). Cognitive reserve and cognitive performance in healthy Latvian seniors. Society. Integration. Education. Proceedings of the International Scientific Conference, 7, 261–269. https://doi.org/10.17770/sie2018vol1.3221
Szepietowska, E. (2019). Cognitive reserve as a factor determining the level of cognitive functions in adults: a preliminary report. Journal of Psychiatry and Clinical Psychology, 19, 32–41. https://doi.org/10.15557/PiPK.2019.0005
Trigg, R., Jones, R., & Skevington, S. (2007). Can people with mild to moderate dementia provide reliable answers about their quality of life? Age and Ageing, 36, 663–669. https://doi.org/10.1093/ageing/afm077
Valenzuela, M., & Sachdev, P. (2009). Can cognitive exercise prevent the onset of dementia? Systematic review of randomized clinical trials with longitudinal follow-up. American Journal of Geriatric Psychiatry, 17, 179–187. https://doi.org/10.1097/JGP.0b013e3181953b57
Van Dijk, K., Van Gerven, P., Van Boxtel, M., Van der Elst, W., & Jolles, J. (2008). No protective effects of education during normal cognitive aging: results from the 6-year follow-up of the Maastricht Aging Study. Psychology and Aging, 23, 119–130. https://doi.org/10.1037/0882-7974.23.1.119
Vinkers, D., Gussekloo, J., Stek, M., Westendorp, R., & van der Mast, R. (2004). Temporal relation between depression and cognitive impairment in old age: prospective population based study. British Medical Journal, 329, 881. https://doi.org/10.1136/bmj.38216.604664.DE
Wheeler, L., & Reis, H. (1991). Self-recording of everyday life events: origins, types, uses. Journal of Personality, 59, 339–354. https://doi.org/10.1111/j.1467-6494.1991.tb00252.x
Wild, K., Mattek, N., Austin, D., & Kaye, J. (2015). “Are You Sure?”: Lapses in self-reported activities among healthy older adults reporting online. Journal of Applied Gerontology, 35, 627–641. https://doi.org/10.1177/0733464815570667
Wilson, R., Yu, L., Lamar, M., Schneider, J., Boyle, P., & Bennett, B. (2019). Education and cognitive reserve in old age. Neurology, 92, e1041–e1050. https://doi.org/10.1212/WNL.0000000000007036
Zahodne, L., Glymour, M., Sparks, C., Bontempo, D., Dixon, R., MacDonald, S., & Manly, J. (2011). Education does not slow cognitive decline with aging: 12-year evidence from the Victoria longitudinal study. Journal of the International Neuropsychological Society, 17, 1039–1046. https://doi.org/10.1017/S1355617711001044
Zaninotto, P., Batty, G., Allerhand, M., & Deary, I. (2018). Cognitive function trajectories and their determinants in older people: 8 years of follow-up in the English Longitudinal Study of Ageing. Journal of Epidemiology and Community Health, 72, 685–694. https://doi.org/10.1136/jech-2017-210116