Reply to Cognitive Reserve: Predictor of Onset of Postoperative Delirium in Older Adults?
Reply to Cognitive Reserve: Predictor of Onset of Postoperative Delirium in Older Adults?
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回复认知储备：老年人术后谵妄发生的预测因子？
DOI：
10.1111/jgs.14593
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发表时间：
2017
影响因子：
6.3
通讯作者：
Verghese,Joe
中科院分区：
文献类型：
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作者：
Verghese,Joe
尊敬的编辑，我感谢朱和同事们对我们报告的评论，即较高水平的认知储备，通过参与认知休闲活动来衡量，降低了老年手术患者术后谵妄的风险和严重程度。1，2他们认为肌肉功能不仅可以作为谵妄预防策略的目标，而且肌肉功能可以作为认知储备措施。认知储备的概念假设，一些个体特征有助于在面对累积的大脑病理时保持认知功能。[3]认知储备的经典定义包括被动机制和主动机制。3早期的工作提出，较高的认知储备提供了一种解剖学缓冲（也称为脑储备），通过这种缓冲，继发于脑损伤或病理的更大的神经元或突触损失可以在表现出临床症状之前持续。在主动模型中，认知储备被认为是通过积极利用各种机制来科普脑损伤，例如招募预先存在的认知网络，提高大脑处理效率，或通过招募补偿性大脑网络。3增强肌肉功能的活动可能对改善或维持衰老中的认知功能有适度的影响; 5然而，这种关联并不等同于认知储备的良好衡量标准。在被动和主动认知储备模型下，3肌肉结构和生物学远离潜在的认知过程和大脑基质，可能更直接地有助于认知储备。因此，虽然我同意应该将增加认知储备的休闲活动作为谵妄预防策略进行探索，但我不同意肌肉功能是表征认知储备的良好代理。2
Dear Editor, I appreciate Zhu and colleagues’ comments on our report that higher levels of cognitive reserve, measured using participation in cognitive leisure activities, reduced risk and severity of post-operative delirium in older surgical patients. 1, 2 They suggest that muscle function could not only be a target for delirium preventive strategies but also that muscle function could serve as a cognitive reserve measure. The concept of cognitive reserve postulates that some individual characteristics help maintains cognitive function in the face of accumulating brain pathology. 3 Classical definitions of cognitive reserve incorporate both passive and active mechanisms. 3 Early work proposed that higher cognitive reserve provides an anatomic buffer (also termed brain reserve) by which greater neuronal or synaptic loss secondary to brain injury or pathology can be sustained before manifesting clinical symptoms. 3, 4 In active models, cognitive reserve is thought to cope with brain damage by actively utilizing various mechanisms such as recruiting pre-existing cognitive networks, improving efficiency of brain processing, or by enlisting compensatory brain networks. 3 Activities that enhance muscle function may have modest effects on improving or maintaining cognitive function in aging; 5 however, this association does not equate to being a good measure of cognitive reserve. Under both passive and active cognitive reserve models, 3 muscle structure and biology are distal to the underlying cognitive processes and brain substrates that may more directly contribute to cognitive reserve. Hence, while I agree that leisure activities that increase cognitive reserve should be explored as a delirium preventive strategy, I do not agree that muscle function is a good proxy for characterizing cognitive reserve. 2