Cognitive Reserve Attenuates the Relation between Gastrointestinal Diseases and Subsequent Decline in Executive Functioning

Ihle, Andreas; Gouveia, Élvio R.; Gouveia, Bruna R.; Zuber, Sascha; Kliegel, Matthias · 2019 · Crossref

DOI: 10.1159/000505617

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Summary

This study investigates whether cognitive reserve moderates the longitudinal relationship between gastrointestinal diseases and subsequent decline in executive functioning among older adults. While previous research has linked gastrointestinal conditions, such as peptic ulcer disease and chronic constipation, to increased risks of cognitive impairment, the specific role of cognitive reserve in this context remained unexplored. The authors aimed to determine if lifelong cognitive stimulation—proxied by education, occupational cognitive demand, and leisure activity engagement—could buffer against the detrimental effects of these diseases on executive function over time. The researchers analyzed longitudinal data from 897 older adults (mean age 74.33 years) participating in two waves of the Vivre-Leben-Vivere survey, conducted six years apart. Executive functioning was assessed using completion times on the Trail Making Test parts A and B. Gastrointestinal diseases were self-reported at the first wave, and cognitive reserve proxies were measured using the Cognitive Reserve Index questionnaire. The study employed latent change score modeling to examine how gastrointestinal diseases, age, sex, and cognitive reserve proxies predicted changes in executive functioning, specifically testing for interactions between disease status and reserve proxies. The results indicated that gastrointestinal diseases showed a trend toward predicting a steeper decline in executive functioning (increased TMT completion time), though this main effect was not statistically significant. However, a significant interaction was found between gastrointestinal diseases and past leisure activity engagement. For individuals with low leisure activity engagement, gastrointestinal diseases significantly predicted a greater decline in executive functioning over the six-year period. In contrast, for those with high leisure activity engagement, the relationship between gastrointestinal diseases and cognitive decline was non-significant. Education and cognitive demand of jobs did not predict changes in executive functioning, nor did they interact with gastrointestinal diseases to moderate decline. Older age and lower leisure activity engagement independently predicted greater declines in executive function. These findings suggest that cognitive reserve, specifically accumulated through lifelong leisure activity engagement, attenuates the negative impact of gastrointestinal diseases on executive functioning. The study highlights that while early-life factors like education contribute to cognitive reserve, leisure activities in adulthood and old age play a crucial role in protecting against disease-related cognitive decline. This implies that promoting stimulating leisure activities throughout life may help maintain executive functioning in older adults, even in the presence of gastrointestinal health issues. The authors note limitations, including the reliance on self-reported disease data, and recommend future studies include medical records and a broader range of cognitive abilities.

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• cognitive impairment