Cognitive Reserve Factors in a Developing Country: Education and Occupational Attainment Lower the Risk of Dementia in a Sample of Lebanese Older Adults

Background: Dementia secondary to neurodegenerative diseases is prevalent among older adults and leads to social, psychological and economic burden on patients, caregivers and the community as a whole. Cognitive reserve factors such as education, and mental stimulation among others were hypothesized to contribute to the resilience against age-related cognitive impairment. Educational attainment, occupation complexity, physical activity, and leisure activity are explored in the context of protecting the older adults' cognitive function. We investigated the cognitive reserve effect on dementia, cognitive decline and impairment, and global cognitive function. Methods: This study is a secondary analysis of data from a cross-sectional, community-based cohort study that aimed at investigating factors associated with dementia and their prevalence. The sample was of 508 community based older adults in Lebanon, aged 65 years and above in addition to 502 informants designated by these older adults. Older adults and informants answered structured questionnaires administered by interviewers, as well as a physical assessment and a neurological examination. Older adults were diagnosed for dementia. Global cognitive function, depression, and cognitive decline were assessed. Results: Older adults with dementia had lower levels of education, and attained lower occupational complexity. Factors such as high education, complex occupation attainment, and leisure activity, significantly predicted better global cognitive function. An older adult who attained high education levels or high complexity level occupation was 7.1 or 4.6 times more likely to have better global cognitive function than another who attained lower education or complexity level occupation respectively. Conclusion: These results suggest that cognitive reserve factors ought to be taken into consideration clinically during the course of dementia diagnosis and when initiating community-based preventive strategies.