Association of Cognitive Reserve and Chronic Disease Comorbidity with the Risk of Progression from Subjective Cognitive Decline to Objective Cognitive Impairment: A Cohort Study Among Chinese Community-Dwelling Older Adults.
- 1Department of Psychiatry, The Affiliated Mental Health Center of Jiangnan University, Wuxi, Jiangsu Province, 214151, People's Republic of China.
- 2Department of Psychology, The Affiliated Mental Health Center of Jiangnan University, Wuxi, Jiangsu Province, 214151, People's Republic of China.
Abstract
Although cognitive reserve (CR) and chronic disease comorbidity (CDC) are closely related to cognitive trajectories, their independent and combined effects on objective cognitive impairment (OCI) in subjective cognitive decline (SCD) remain insufficiently evidenced. This study aimed to investigate the independent effects and interactions between CR and CDC on the risk of OCI in community-dwelling older adults with SCD. This prospective cohort study included 605 community-dwelling SCD patients aged ≥60 years from Wuxi City in 2022, with a 3-year follow-up to assess progression to OCI (mild cognitive impairment or dementia). Cox proportional hazards (Cox PH) regression models were used to analyze the associations and interactions between CR, CDC, and OCI risk. Kaplan-Meier curves were employed to compare the probability of remaining free from OCI across different combinations of CR and CDC. During follow-up, 195 SCD patients progressed to OCI. Cox PH regression identified low CR (LCR) and high CDC (HCDC) as factors independently associated with elevated OCI risk in SCD patients. Compared with the LCR group, the high CR (HCR) group had a significantly lower risk of cognitive progression (HR = 0.473, 95% CI: 0.350-0.640, P < 0.001); in contrast, the HCDC group had a higher risk than the low CDC (LCDC) group (HR = 5.286, 95% CI: 3.772-7.409, P < 0.001). A significant positive additive interaction was observed between CR and CDC. Survival analysis revealed that patients with HCDC combined with LCR exhibited the highest risk of progression, while those with LCDC and HCR demonstrated the highest probability of maintaining normal cognition. HCR was associated with lower risk of OCI among community-dwelling older adults with SCD, whereas LCR and HCDC showed synergistic association with elevated cognitive progression risk. Moreover, HCR remained independently associated with reduced risk even under HCDC exposure.
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BibTeX
@article{zhao2026association,
title = {{Association of Cognitive Reserve and Chronic Disease Comorbidity with the Risk of Progression from Subjective Cognitive Decline to Objective Cognitive Impairment: A Cohort Study Among Chinese Community-Dwelling Older Adults.}},
author = {Yan Zhao and Yue Wu and Bixiu Yang and Zhiqun Mao and Jiao Yu},
journal = {Neuropsychiatric disease and treatment},
year = {2026},
month = nov,
doi = {10.2147/ndt.s652925},
url = {https://europepmc.org/article/MED/42996786},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Association of Cognitive Reserve and Chronic Disease Comorbidity with the Risk of Progression from Subjective Cognitive Decline to Objective Cognitive Impairment: A Cohort Study Among Chinese Community-Dwelling Older Adults.
AU - Yan Zhao
AU - Yue Wu
AU - Bixiu Yang
AU - Zhiqun Mao
AU - Jiao Yu
PY - 2026
DA - 2026/11/01
JO - Neuropsychiatric disease and treatment
DO - 10.2147/ndt.s652925
UR - https://europepmc.org/article/MED/42996786
AB - Although cognitive reserve (CR) and chronic disease comorbidity (CDC) are closely related to cognitive trajectories, their independent and combined effects on objective cognitive impairment (OCI) in subjective cognitive decline (SCD) remain insufficiently evidenced. This study aimed to investigate the independent effects and interactions between CR and CDC on the risk of OCI in community-dwelling older adults with SCD. This prospective cohort study included 605 community-dwelling SCD patients aged ≥60 years from Wuxi City in 2022, with a 3-year follow-up to assess progression to OCI (mild cognitive impairment or dementia). Cox proportional hazards (Cox PH) regression models were used to analyze the associations and interactions between CR, CDC, and OCI risk. Kaplan-Meier curves were employed to compare the probability of remaining free from OCI across different combinations of CR and CDC. During follow-up, 195 SCD patients progressed to OCI. Cox PH regression identified low CR (LCR) and high CDC (HCDC) as factors independently associated with elevated OCI risk in SCD patients. Compared with the LCR group, the high CR (HCR) group had a significantly lower risk of cognitive progression (HR = 0.473, 95% CI: 0.350-0.640, P < 0.001); in contrast, the HCDC group had a higher risk than the low CDC (LCDC) group (HR = 5.286, 95% CI: 3.772-7.409, P < 0.001). A significant positive additive interaction was observed between CR and CDC. Survival analysis revealed that patients with HCDC combined with LCR exhibited the highest risk of progression, while those with LCDC and HCR demonstrated the highest probability of maintaining normal cognition. HCR was associated with lower risk of OCI among community-dwelling older adults with SCD, whereas LCR and HCDC showed synergistic association with elevated cognitive progression risk. Moreover, HCR remained independently associated with reduced risk even under HCDC exposure.
SN - 1176-6328
SN - 1178-2021
ER -