We explored the effect of education and occupational complexity on the
rate of cognitive decline (as measured by the Mini-Mental State
Examination) in 171 patients with a confirmed Alzheimer's disease
(AD) diagnosis. Complexity was measured as substantive complexity of work
and complexity of work with data, people, and things. Average lifetime
occupational complexity was calculated based on years at each occupation.
Participants were followed for an average of 2.5 years and 3.7 visits. In
multivariate mixed-effects models, high education, high substantive
complexity, and high complexity of work with data and people predicted
faster rates of cognitive decline, controlling for age, gender, native
language, dementia severity, and entry into the analyses at initial
versus follow-up testing. These results provide support for the
concept of cognitive reserve according to which greater reserve may
postpone clinical onset of AD but also accelerate cognitive decline after
the onset. (JINS, 2006, 12, 147–152.)