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Cognitive reserve: Implications for diagnosis and prevention of Alzheimer’s disease

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Abstract

Epidemiologic evidence suggests that higher occupational attainment and education, as well as increased participation in intellectual, social, and physical aspects of daily life, are associated with slower cognitive decline in healthy elderly and may reduce the risk of incident Alzheimer’s disease (AD). There is also evidence from structural and functional imaging studies that patients with such life experiences can tolerate more AD pathology before showing signs of clinical dementia. It has been hypothesized that such aspects of life experience may result in functionally more efficient cognitive networks and, therefore, provide a cognitive reserve that delays the onset of clinical manifestations of dementia. In this article, we review some of the relevant literature of the noted associations between markers of cognitive reserve and AD and discuss the possible mechanisms that may explain these associations.

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References and Recommended Reading

  1. Katzman R, Terry R, DeTeresa R, et al.: Clinical, pathological, and neurochemical changes in dementia: a subgroup with preserved mental status and numerous neocortical plaques. Ann Neurol 1988, 23:138–144.

    Article  CAS  PubMed  Google Scholar 

  2. Katzman R, Aronson M, Fuld P, et al.: Development of dementing illnesses in an 80-year-old volunteer cohort. Ann Neurol 1989, 25:317–324.

    Article  CAS  PubMed  Google Scholar 

  3. Ince P: Pathological correlates of late-onset dementia in a multicenter community-based population in England and Wales. Lancet 2001, 357:169–175.

    Article  Google Scholar 

  4. Crystal H, Dickson D, Fuld P, et al.: Clinico-pathologic studies in dementia: nondemented subjects with pathologically confirmed Alzheimer’s disease. Neurology 1988, 38:1682–1687.

    Article  CAS  PubMed  Google Scholar 

  5. Morris JC, Storandt M, McKeel DW Jr, et al.: Cerebral amyloid deposition and diffuse plaques in "normal" aging: Evidence for presymptomatic and very mild Alzheimer’s disease. Neurology 1996, 46:707–719.

    Article  CAS  PubMed  Google Scholar 

  6. Mortimer JA, Snowdon DA, Markesbery WR: Head circumference, education and risk of dementia: findings from the Nun Study. J Clin Exp Neuropsychol 2003, 25:671–679.

    Article  PubMed  Google Scholar 

  7. Stern Y: What is cognitive reserve? Theory and research application of the reserve concept. J Int Neuropsychol Soc 2002, 8:448–460. This manuscript lays the theoretical background and attempts to develop a coherent theoretical account of CR. It presents the subdivision into passive (threshold) and active (efficient network utilization or recruitment) models. In addition, it discusses varying aspects of the CR concept for healthy and diseased populations.

    Article  PubMed  Google Scholar 

  8. Richards M, Sacker A: Lifetime antecedents of cognitive reserve. J Clin Exp Neuropsychol 2003, 25:614–624.

    Article  PubMed  Google Scholar 

  9. Dartigues JF, Gagnon M, Mazaux JM, et al.: Occupation during life and memory performance in nondemented French elderly community residents. Neurology 1992, 42:1697–1701.

    Article  CAS  PubMed  Google Scholar 

  10. Helmer C, Letenneur L, Rouch I, et al.: Occupation during life and risk of dementia in French elderly community residents. J Neurol Neurosurg Psychiatry 2001, 71:303–309.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Jorm AF, Rodgers B, Henderson AS, et al.: Occupation type as a predictor of cognitive decline and dementia in old age. Age Aging 1998, 27:477–483.

    Article  CAS  Google Scholar 

  12. Anttila T, Helkala EL, Kivipelto M, et al.: Midlife income, occupation, APOE status, and dementia: a population-based study. Neurology 2002, 59:887–893.

    Article  CAS  PubMed  Google Scholar 

  13. Paykel ES, Brayne C, Huppert FA, et al.: Incidence of dementia in a population older than 75 years in the United Kingdom. Arch Gen Psychiatry 1994, 51:325–332.

    Article  CAS  PubMed  Google Scholar 

  14. Evans DA, Hebert LE, Beckett LA, et al.: Education and other measures of socioeconomic status and risk of incident Alzheimer disease in a defined population of older persons. Arch Neurol 1997, 54:1399–1405.

    Article  CAS  PubMed  Google Scholar 

  15. Stern Y, Gurland B, Tatemichi TK, et al.: Influence of education and occupation on the incidence of Alzheimer’s disease. JAMA 1994, 271:1004–1010.

    Article  CAS  PubMed  Google Scholar 

  16. Bickel H, Cooper B: Incidence and relative risk of dementia in an urban elderly population: findings of a prospective field study. Psychol Med 1994, 24:179–192.

    Article  CAS  PubMed  Google Scholar 

  17. Zhang X, Li C, Zhang M: Psychosocial risk factors of Alzheimer’s disease. Zhonghua Yi Xue Za Zhi 1999, 79:335–338.

    CAS  PubMed  Google Scholar 

  18. Qiu C, Karp A, von Strauss E, et al.: Lifetime principal occupation and risk of Alzheimer’s disease in the Kungsholmen project. Am J Ind Med 2003, 43:204–211.

    Article  PubMed  Google Scholar 

  19. Schmand B, Smit JH, Geerlings MI, Lindeboom J: The effects of intelligence and education on the development of dementia. A test of the brain reserve hypothesis. Psychol Med 1997, 27:1337–1344.

    Article  CAS  PubMed  Google Scholar 

  20. White L, Katzman R, Losonczy K, et al.: Association of education with incidence of cognitive impairment in three established populations for epidemiologic studies of the elderly. J Clin Epidemiol 1994, 47:363–374.

    Article  CAS  PubMed  Google Scholar 

  21. Li G, Shen YC, Chen CH, et al.: A three-year follow-up study of age-related dementia in an urban area of Beijing. Acta Psychiatr Scand 1991, 83:99–104.

    Article  CAS  PubMed  Google Scholar 

  22. Chandra V, Pandav R, Dodge HH, et al.: Incidence of Alzheimer’s disease in a rural community in India: the Indo-US study. Neurology 2001, 57:985–989.

    Article  CAS  PubMed  Google Scholar 

  23. Hall KS, Gao S, Unverzagt FW, Hendrie HC: Low education and childhood rural residence: risk for Alzheimer’s disease in African Americans. Neurology 2000, 54:95–99.

    Article  CAS  PubMed  Google Scholar 

  24. Cobb JL, Wolf PA, Au R, et al.: The effect of education on the incidence of dementia and Alzheimer’s disease in the Framingham Study. Neurology 1995, 45:1707–1712.

    Article  CAS  PubMed  Google Scholar 

  25. Graves AB, Larson EB, Edland SD, et al.: Prevalence of dementia and its subtypes in the Japanese American population of King County, Washington state. The Kame Project. Am J Epidemiol 1996, 144:760–771.

    Article  CAS  PubMed  Google Scholar 

  26. Letenneur L, Commenges D, Dartigues JF, et al.: Incidence of dementia and Alzheimer’s disease in elderly community residents of south-western France. Int J Epidemiol 1994, 23:1256–1261.

    Article  CAS  PubMed  Google Scholar 

  27. Qiu C, Backman L, Winblad B, et al.: The influence of education on clinically diagnosed dementia incidence and mortality data from the Kungsholmen Project. Arch Neurol 2001, 58:2034–2039.

    Article  CAS  PubMed  Google Scholar 

  28. Zhang MY, Katzman R, Salmon D, et al.: The prevalence of dementia and Alzheimer’s disease in Shanghai, China: impact of age, gender, and education. Ann Neurol 1990, 27:428–437.

    Article  CAS  PubMed  Google Scholar 

  29. Evans DA, Beckett LA, Albert MS, et al.: Level of education and change in cognitive function in a community population of older persons. Ann Epidemiol 1993, 3:71–77.

    Article  PubMed  Google Scholar 

  30. Launer LJ, Andersen K, Dewey ME, et al.: Rates and risk factors for dementia and Alzheimer’s disease: results from EURODEM pooled analyses. EURODEM Incidence Research Group and Work Groups. European Studies of Dementia. Neurology 1999, 52:78–84.

    Article  CAS  PubMed  Google Scholar 

  31. Bennett DA, Wilson RS, Schneider JA, et al.: Education modifies the relation of AD pathology to level of cognitive function in older persons. Neurology 2003, 60:1909–1915. This report derives from the Religious Order Study and included 130 older Catholic clergy undergoing annual cognitive function testing and brain autopsy at the time of death. Cognitive function before death was affected both by the global AD pathology score and years of formal education. The association between cognitive function and AD pathology was modified by education, with less effect of AD pathology on cognitive function for each additional year of education.

    Article  CAS  PubMed  Google Scholar 

  32. Albert MS, Jones K, Savage CR, et al.: Predictors of cognitive change in older persons: MacArthur studies of successful aging. Psychol Aging 1995, 10:578–589.

    Article  CAS  PubMed  Google Scholar 

  33. Butler SM, Ashford JW, Snowdon DA: Age, education, and changes in the Mini-Mental State Exam scores of older women: findings from the Nun Study. J Am Geriatr Soc 1996, 44:675–681.

    Article  CAS  PubMed  Google Scholar 

  34. Chodosh J, Reuben DB, Albert MS, Seeman TE: Predicting cognitive impairment in high-functioning community-dwelling older persons: MacArthur Studies of Successful Aging. J Am Geriatr Soc 2002, 50:1051–1060.

    Article  PubMed  Google Scholar 

  35. Christensen H, Korten AE, Jorm AF, et al.: Education and decline in cognitive performance: compensatory but not protective. Int J Geriatr Psychiatry 1997, 12:323–330.

    Article  CAS  PubMed  Google Scholar 

  36. Farmer ME, Kittner SJ, Rae DS, et al.: Education and change in cognitive function. The Epidemiologic Catchment Area Study. Ann Epidemiol 1995, 5:1–7.

    Article  CAS  PubMed  Google Scholar 

  37. Snowdon DA, Ostwald SK, Kane RL: Education, survival, and independence in elderly Catholic sisters, 1936–1988. Am J Epidemiol 1989, 130:999–1012.

    Article  CAS  PubMed  Google Scholar 

  38. Lyketsos CG, Chen LS, Anthony JC: Cognitive decline in adulthood: an 11.5-year follow-up of the Baltimore Epidemiologic Catchment Area Study. Am J Psychiatry 1999, 156:58–65.

    Article  CAS  PubMed  Google Scholar 

  39. Colsher PL, Wallace RB: Longitudinal application of cognitive function measures in a defined population of communitydwelling elders. Ann Epidemiol 1991, 1:215–230.

    Article  CAS  PubMed  Google Scholar 

  40. van Praag H, Kempermann G, Gage FH: Running increases cell proliferation and neurogenesis in the adult mouse dentate gyrus. Nat Neurosci 1999, 2:266–270.

    Article  PubMed  Google Scholar 

  41. Rogers RL, Meyer JS, Mortel KF: After reaching retirement age physical activity sustains cerebral perfusion and cognition. J Am Geriatr Soc 1990, 38:123–128.

    Article  CAS  PubMed  Google Scholar 

  42. Dustman RE, Ruhling RO, Russell EM, et al.: Aerobic exercise training and improved neuropsychological function of older individuals. Neurobiol Aging 1984, 5:35–42.

    Article  CAS  PubMed  Google Scholar 

  43. Spirduso WW: Physical fitness, aging, and psychomotor speed: a review. J Gerontol 1980, 35:850–865.

    Article  CAS  PubMed  Google Scholar 

  44. Fordyce DE, Farrar RP: Physical activity effects on hippocampal and parietal cortical cholinergic function and spatial learning in F344 rats. Behav Brain Res 1991, 43:115–123.

    Article  CAS  PubMed  Google Scholar 

  45. Gomez-Pinilla F, So V, Kesslak JP: Spatial learning and physical activity contribute to the induction of fibroblast growth factor: neural substrates for increased cognition associated with exercise. Neuroscience 1998, 85:53–61.

    Article  CAS  PubMed  Google Scholar 

  46. Neeper SA, Gomez-Pinilla F, Choi J, Cotman C: Exercise and brain neurotrophins. Nature 1995, 373:109.

    Article  CAS  PubMed  Google Scholar 

  47. Cotman CW, Engesser-Cesar C: Exercise enhances and protects brain function. Exerc Sport Sci Rev 2002, 30:75–79.

    Article  PubMed  Google Scholar 

  48. Broe GA, Creasey H, Jorm AF, et al.: Health habits and risk of cognitive impairment and dementia in old age: a prospective study on the effects of exercise, smoking and alcohol consumption. Aust N Z J Pub Health 1998, 22:621–623.

    Article  CAS  Google Scholar 

  49. Wilson RS, Mendes de Leon CF, Barnes L, et al.: Participation in cognitively stimulating activities and risk of incident alzheimer disease. JAMA 2002, 287:742–748. A dementia incidence cohort reporting reduced risk for development of AD for subjects with increased cognitive activities at baseline assessment (when dementia free).

    Article  PubMed  Google Scholar 

  50. Wang HX, Karp A, Winblad B, Fratiglioni L: late-life engagement in social and leisure activities is associated with a decreased risk of dementia: a longitudinal study from the Kungsholmen Project. Am J Epidemiol 2002, 155:1081–1087.

    Article  PubMed  Google Scholar 

  51. Verghese J, Lipton RB, Katz MJ, et al.: leisure activities and the risk of dementia in the elderly. N Engl J Med 2003, 348:2508–2516.

    Article  PubMed  Google Scholar 

  52. Carmelli D, Swan GE, LaRue A, Eslinger PJ: Correlates of change in cognitive function in survivors from the Western Collaborative Group Study. Neuroepidemiology 1997, 16:285–295.

    Article  CAS  PubMed  Google Scholar 

  53. Schuit AJ, Feskens EJ, Launer LJ, Kromhout D: Physical activity and cognitive decline, the role of the apolipoprotein e4 allele. Med Sci Sports Exerc 2001, 33:772–777.

    Article  CAS  PubMed  Google Scholar 

  54. Dik M, Deeg DJ, Visser M, Jonker C: Early life physical activity and cognition at old age. J Clin Exp Neuropsychol 2003, 25:643–653.

    Article  PubMed  Google Scholar 

  55. Yaffe K, Barnes D, Nevitt M, et al.: A prospective study of physical activity and cognitive decline in elderly women: women who walk. Arch Intern Med 2001, 161:1703–1708.

    Article  CAS  PubMed  Google Scholar 

  56. Rogers RL, Meyer JS, Mortel KF: After reaching retirement age physical activity sustains cerebral perfusion and cognition. J Am Geriatr Soc 1990, 38:123–128.

    Article  CAS  PubMed  Google Scholar 

  57. Yoshitake T, Kiyohara Y, Kato I, et al.: Incidence and risk factors of vascular dementia and Alzheimer’s disease in a defined elderly Japanese population: the Hisayama Study. Neurology 1995, 45:1161–1168.

    Article  CAS  PubMed  Google Scholar 

  58. Laurin D, Verreault R, Lindsay J, et al.: Physical activity and risk of cognitive impairment and dementia in elderly persons. Arch Neurol 2001, 58:498–504.

    Article  CAS  PubMed  Google Scholar 

  59. Scarmeas N, Levy G, Tang M, et al.: Influence of leisure activity on the incidence of Alzheimer’s disease. Neurology 2001, 57:2236–2242.

    Article  CAS  PubMed  Google Scholar 

  60. Churchill JD, Galvez R, Colcombe S, et al.: Exercise, experience and the aging brain. Neurobiol Aging 2002, 23:941–955.

    Article  PubMed  Google Scholar 

  61. Colcombe S, Kramer AF: Fitness effects on the cognitive function of older adults: a meta-analytic study. Psychol Sci 2003, 14:125–130. A meta-analysis of the cognitive effects of 18 aerobic fitness-training intervention studies for healthy elderly patients. Fitness training was found to have robust but selective benefits for cognition, in particular for executive-control processes. The magnitude of fitness effects on cognition was also moderated by a number of factors, including the length of the fitness-training intervention, the type of the intervention, the duration of training sessions, and the gender of the study participants.

    Article  PubMed  Google Scholar 

  62. Scarmeas N, Stern Y: Cognitive reserve and lifestyle. J Clin Exp Neuropsychol 2003, 25:625–633. A review of both epidemiologic and imaging studies addressing the association between everyday leisure activities and cognition.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Salthouse T: Theoretical Perspectives on Cognitive Aging. Hillsdale, NJ: L. Erlbaum Associates; 1991.

    Google Scholar 

  64. Hultsch DF, Hertzog C, Small BJ, Dixon RA: Use it or lose it: engaged lifestyle as a buffer of cognitive decline in aging? Psychol Aging 1999, 14:245–263.

    Article  CAS  PubMed  Google Scholar 

  65. Fabrigoule C, Letenneur L, Dartigues JF, et al.: Social and leisure activities and risk of dementia: a prospective longitudinal study. J Am Geriatr Soc 1995, 43:485–490.

    Article  CAS  PubMed  Google Scholar 

  66. Helmer C, Damon D, Letenneur L, et al.: Marital status and risk of Alzheimer’s disease: a French population-based cohort study. Neurology 1999, 53:1953–1958.

    Article  CAS  PubMed  Google Scholar 

  67. Fratiglioni L, Wang HX, Ericsson K, et al.: Influence of social network on occurrence of dementia: a community-based longitudinal study. Lancet 2000, 355:1315–1319.

    Article  CAS  PubMed  Google Scholar 

  68. Kempermann G, Gast D, Gage FH: Neuroplasticity in old age: sustained fivefold induction of hippocampal neurogenesis by long-term environmental enrichment. Ann Neurol 2002, 52:135–143.

    Article  PubMed  Google Scholar 

  69. Kempermann G, Kuhn HG, Gage FH: More hippocampal neurons in adult mice living in an enriched environment. Nature 1997, 386:493–495.

    Article  CAS  PubMed  Google Scholar 

  70. Katzman R: Education and the prevalence of dementia and Alzheimer’s disease. Neurology 1993, 43:13–20.

    Article  CAS  PubMed  Google Scholar 

  71. Coffey CE, Saxton JA, Ratcliff G, et al.: Relation of education to brain size in normal aging: implications for the reserve hypothesis. Neurology 1999, 53:189–196.

    Article  CAS  PubMed  Google Scholar 

  72. Coffey CE, Wilkinson WE, Parashos IA, et al.: Quantitative cerebral anatomy of the aging human brain: a cross-sectional study using magnetic resonance imaging. Neurology 1992, 42(3Pt 1):527–536.

    Article  CAS  PubMed  Google Scholar 

  73. Passe TJ, Rajagopalan P, Tupler LA, et al.: Age and sex effects on brain morphology. Prog Neuropsychopharmacol Biol Psychiatry 1997, 21:1231–1237.

    Article  CAS  PubMed  Google Scholar 

  74. Kidron D, Black SE, Stanchev P, et al.: Quantitative MR volumetry in Alzheimer’s disease. Topographic markers and the effects of sex and education. Neurology 1997, 49:1504–1512.

    Article  CAS  PubMed  Google Scholar 

  75. Maguire EA, Gadian DG, Johnsrude IS, et al.: Navigationrelated structural change in the hippocampi of taxi drivers. Proc Natl Acad Sci U S A 2000, 97:4398–4403.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Colcombe SJ, Erickson KI, Raz N, et al.: Aerobic fitness reduces brain tissue loss in aging humans. J Gerontol A Biol Sci Med Sci 2003, 58:176–180. Although limited by its cross-sectional and observational (ie, nonrandomized) character, this is the first empirical suggestion of the association between physical fitness and brain tissue density.

    Article  PubMed  Google Scholar 

  77. Stern Y, Alexander GE, Prohovnik I, et al.: Relationship between lifetime occupation and parietal flow: implications for a reserve against Alzheimer’s disease pathology. Neurology 1995, 45:55–60.

    Article  CAS  PubMed  Google Scholar 

  78. Stern Y, Alexander GE, Prohovnik I, Mayeux R: Inverse relationship between education and parietotemporal perfusion deficit in Alzheimer’s disease. Ann Neurol 1992, 32:371–375.

    Article  CAS  PubMed  Google Scholar 

  79. Alexander GE, Furey ML, Grady CL, et al.: Association of premorbid intellectual function with cerebral metabolism in Alzheimer’s disease: implications for the cognitive reserve hypothesis. Am J Psychiatry 1997, 154:165–172.

    Article  CAS  PubMed  Google Scholar 

  80. Scarmeas N, Zarahn E, Anderson KE, et al.: Association of life activities with cerebral blood flow in Alzheimer disease: implications for the cognitive reserve hypothesis. Arch Neurol 2003, 60:359–365. In this report, the authors use H2O15 PET to assess cerebral perfusion in AD patients and control subjects and expand previously noted association between imaging surrogates of AD pathology and some CR indices (such as IQ, occupation, and education). They notice similar associations for physical, social, and intellectual activities. They also show that the associations are over and above those for other CR indices, such as education and IQ.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Gray JR, Chabris CF, Braver TS: Neural mechanisms of general fluid intelligence. Nat Neurosci 2003, 6:316–322.

    Article  CAS  PubMed  Google Scholar 

  82. Stern Y, Zarahn E, Hilton HJ, et al.: Exploring the neural basis of cognitive reserve. J Clin Exp Neuropsychol 2003, 25:691–701.

    Article  PubMed  Google Scholar 

  83. Scarmeas N, Zarahn E, Anderson KE, et al.: Cognitive reserve modulates functional brain responses during memory tasks: a PET study in healthy young and elderly subjects. Neuroimage 2003, 19:1215–1227.

    Article  PubMed  Google Scholar 

  84. Scarmeas N, Zarahn E, Anderson KE, et al.: Cognitive reservemediated modulation of positron emission tomographic activations during memory tasks in Alzheimer disease. Arch Neurol 2004, 61:73–78.

    Article  PubMed  PubMed Central  Google Scholar 

  85. Friedland RP: Epidemiology, education, and the ecology of Alzheimer’s disease. Neurology 1993, 43:246–249.

    Article  CAS  PubMed  Google Scholar 

  86. Eriksson PS, Perfilieva E, Bjork-Eriksson T, et al.: Neurogenesis in the adult human hippocampus. Nat Med 1998, 4:1313–1317.

    Article  CAS  PubMed  Google Scholar 

  87. Johansson CB, Svensson M, Wallstedt L, et al.: Neural stem cells in the adult human brain. Exp Cell Res 1999, 253:733–736.

    Article  CAS  PubMed  Google Scholar 

  88. Kukekov VG, Laywell ED, Suslov O, et al.: Multipotent stem/ progenitor cells with similar properties arise from two neurogenic regions of adult human brain. Exp Neurol 1999, 156:333–344.

    Article  CAS  PubMed  Google Scholar 

  89. Devitt N: Education, occupation, and Alzheimer’s disease. JAMA 1994, 272:1405; author reply 1406.

    Article  CAS  PubMed  Google Scholar 

  90. Del Ser T, Hachinski V, Merskey H, Munoz DG: An autopsy-verified study of the effect of education on degenerative dementia. Brain 1999, 122(Pt 12):2309–2319.

    PubMed  Google Scholar 

  91. Cohen CI: Education, occupation, and Alzheimer’s disease. JAMA 1994, 272:1405; author reply 1406.

    Article  CAS  PubMed  Google Scholar 

  92. van den BreeMB, Eaves LJ, Dwyer JT: Genetic and environmental influences on eating patterns of twins aged >/=50 y. Am J Clin Nutr 1999, 70:456–465.

    Article  PubMed  Google Scholar 

  93. Koopmans JR, Slutske WS, Heath AC, et al.: The genetics of smoking initiation and quantity smoked in Dutch adolescent and young adult twins. Behav Genet 1999, 29:383–393.

    Article  CAS  PubMed  Google Scholar 

  94. Madden PA, Heath AC, Pedersen NL, et al.: The genetics of smoking persistence in men and women: a multicultural study. Behav Genet 1999, 29:423–431.

    Article  CAS  PubMed  Google Scholar 

  95. Beunen G, Thomis M: Genetic determinants of sports participation and daily physical activity. Int J Obes Relat Metab Disord 1999, 23(Suppl 3):S55-S63.

    Article  PubMed  Google Scholar 

  96. Eaves L, Heath A, Martin N, et al.: Comparing the biological and cultural inheritance of personality and social attitudes in the Virginia 30,000 study of twins and their relatives. Twin Res 1999, 2:62–80.

    Article  CAS  PubMed  Google Scholar 

  97. Bouchard TJ Jr, McGue M, Lykken D, Tellegen A: Intrinsic and extrinsic religiousness: genetic and environmental influences and personality correlates. Twin Res 1999, 2:88–98.

    Article  PubMed  Google Scholar 

  98. Duncan GJ, Brooks-Gunn J, Klebanov PK: Economic deprivation and early childhood development. Child Dev 1994, 65(2 Spec No):296–318.

    Article  CAS  PubMed  Google Scholar 

  99. Sacker A, Schoon I, Bartley M: Social inequality in educational achievement and psychosocial adjustment throughout childhood: magnitude and mechanisms. Soc Sci Med 2002, 55:863–880.

    Article  PubMed  Google Scholar 

  100. McKeown T, Record RG: Relationship between childhood infections and measured intelligence. Br J Prev Soc Med 1976, 30:101–106.

    CAS  PubMed  PubMed Central  Google Scholar 

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Scarmeas, N., Stern, Y. Cognitive reserve: Implications for diagnosis and prevention of Alzheimer’s disease. Curr Neurol Neurosci Rep 4, 374–380 (2004). https://doi.org/10.1007/s11910-004-0084-7

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