Date of Award:


Document Type:


Degree Name:

Doctor of Philosophy (PhD)




JoAnn T. Tschanz


According to the theory of cognitive reserve, cognitively enriching aspects of life experience (e.g., education, occupation, and leisure activity) foster the development of more efficient neural networks and cognitive strategies, enabling individuals to cope more effectively with the pathology of dementia. Using extant data from a population-based study, we examined: (1) the effect of reserve accrued through middle life on course of neuropsychological decline; and (2) the role of ongoing engagement in mentally stimulating leisure activities in rate of general cognitive and functional deterioration. In linear mixed models, level of occupational attainment did not affect rate of cognitive or functional decline, although women were found to undergo more rapid deterioration in cognitive ability. Occupational skill area was associated with trajectory of decline in several neuropsychological domains. Specifically, vocations emphasizing practical, hands-on skills were associated with slower deterioration in auditory-verbal and visual memory, as well as visuospatial and constructional abilities. Teaching and helping professions, in contrast, were associated with more rapid decline in memory and executive functioning. Increased engagement in cognitive leisure activities through late life was associated with slower deterioration in general cognitive ability in mild dementia, but its effects were no longer evident in more severe AD. An understanding of how rate of decline intersects with patients' past histories and efforts to maintain and enhance cognitive capacity will enable clinicians to target areas for cognitive training and rehabilitative therapy.