How education and gender inequalities impact cognitive reserve
The number of people living with dementia in the European Union is predicted to almost double to over 14 million by 2050. While recent pharmaceutical treatments offer the prospect of delaying the onset and severity of dementia, the CRISP project, which was funded by the European Research Council, investigated the contextual factors that leave some people less prone in the first place. The Lancet Commission on dementia prevention found that as much as 45 % of cases are potentially preventable if so-called modifiable risk factors – such as smoking and diet – are addressed. “If we understand how to create environments conducive to building brain-protecting cognitive reserve over a life course, we can introduce supportive policies in education and employment,” says Anja Leist, project coordinator.
Societal modifiable risk factors
CRISP was particularly interested in how educational opportunities and gender influenced ‘cognitive reserve’ – the brain’s ability to adapt its neural networks to compensate for neurological impairment. “Research in the 2000s found a disconnect between cognitive performance later in life and brain pathology, but did find a strong link with education attainment. This suggests that education helps train the brain to build alternative pathways, enabling it to compensate for pathologies like the amyloid depositions associated with dementia. What we didn’t know was how societal conditions affect cognitive reserve,” adds Leist. CRISP investigated how the different education opportunities of men and women related to cognitive performance in later life. The project used longitudinal data, including from SHARE (Survey of Health, Ageing and Retirement in Europe) which has been tracking the health, social and economic situation of individuals over 50 years old, since 2004. This data set of three birth cohorts from 16 European countries and Israel, (almost 47 000 individuals) enabled CRISP to find correlations between educational opportunity at the time of schooling and levels of cognitive functioning more than 30 years later (at 50 to 76 years old). CRISP also developed a methodology exploring how gender bias can reduce opportunities for women to build cognitive reserve in societies with higher gender inequality. This links societal conditions, such as teenage pregnancy rates and career opportunities, to the Lancet Commission framework on dementia. It had also previously been unclear whether women’s higher dementia burden emanated from differences in dementia risk per se or was due to other factors, such as inadequate physical activity being more harmful to women. “Our analysis suggests that higher dementia rates in women are less a result of biology but more because of women’s higher overall risk burden, indicated by lower educational attainment and more unfavourable health risk profiles,” notes Leist. A CRISP collaboration was the first winner of the Health and Medical Sociology Excellence Prize, while CRISP was a joint winner of the Vontobel Prize for Ageing Research (website in German) for its work on ‘Gendered life courses and cognitive functioning in later life’.
Prioritising primary prevention
In 2023, CRISP held a ‘brain health policy’ workshop in Luxembourg with health economists, WHO representatives and neurologists. One recommendation was to include brain health impact assessments in any proposed new health policy. But to ensure better primary prevention, another key project legacy is the GetBrainHealthy initiative for work environments. “Places of employment offer many opportunities for managers and employees to promote brain health, including task organisation, social activities and exercise,” adds Leist. The team remains focused on exploring the mechanisms behind the social determinants of cognitive health, with special interest in possible links between dementia risk and immune system ageing.
Keywords
CRISP, dementia, ageing, cognitive reserve, gender, education, brain, risk
