TY - JOUR
T1 - Measuring Resilience and Resistance in Aging and Alzheimer Disease Using Residual Methods
T2 - A Systematic Review and Meta-analysis
AU - Bocancea, Diana I.
AU - van Loenhoud, Anna C.
AU - Groot, Colin
AU - Barkhof, Frederik
AU - van der Flier, Wiesje M.
AU - Ossenkoppele, Rik
N1 - Publisher Copyright: Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology. Copyright: This record is sourced from MEDLINE/PubMed, a database of the U.S. National Library of Medicine
PY - 2021/9/7
Y1 - 2021/9/7
N2 - BACKGROUND AND OBJECTIVE: There is a lack of consensus on how to optimally define and measure resistance and resilience in brain and cognitive aging. Residual methods use residuals from regression analysis to quantify the capacity to avoid (resistance) or cope (resilience) "better or worse than expected" given a certain level of risk or cerebral damage. We reviewed the rapidly growing literature on residual methods in the context of aging and Alzheimer disease (AD) and performed meta-analyses to investigate associations of residual method-based resilience and resistance measures with longitudinal cognitive and clinical outcomes. METHODS: A systematic literature search of PubMed and Web of Science databases (consulted until March 2020) and subsequent screening led to 54 studies fulfilling eligibility criteria, including 10 studies suitable for the meta-analyses. RESULTS: We identified articles using residual methods aimed at quantifying resistance (n = 33), cognitive resilience (n = 23), and brain resilience (n = 2). Critical examination of the literature revealed that there is considerable methodologic variability in how the residual measures were derived and validated. Despite methodologic differences across studies, meta-analytic assessments showed significant associations of levels of resistance (hazard ratio [HR] [95% confidence interval (CI)] 1.12 [1.07-1.17]; p < 0.0001) and levels of resilience (HR [95% CI] 0.46 [0.32-0.68]; p < 0.001) with risk of progression to dementia/AD. Resilience was also associated with rate of cognitive decline (β [95% CI] 0.05 [0.01-0.08]; p < 0.01). DISCUSSION: This review and meta-analysis supports the usefulness of residual methods as appropriate measures of resilience and resistance, as they capture clinically meaningful information in aging and AD. More rigorous methodologic standardization is needed to increase comparability across studies and, ultimately, application in clinical practice.
AB - BACKGROUND AND OBJECTIVE: There is a lack of consensus on how to optimally define and measure resistance and resilience in brain and cognitive aging. Residual methods use residuals from regression analysis to quantify the capacity to avoid (resistance) or cope (resilience) "better or worse than expected" given a certain level of risk or cerebral damage. We reviewed the rapidly growing literature on residual methods in the context of aging and Alzheimer disease (AD) and performed meta-analyses to investigate associations of residual method-based resilience and resistance measures with longitudinal cognitive and clinical outcomes. METHODS: A systematic literature search of PubMed and Web of Science databases (consulted until March 2020) and subsequent screening led to 54 studies fulfilling eligibility criteria, including 10 studies suitable for the meta-analyses. RESULTS: We identified articles using residual methods aimed at quantifying resistance (n = 33), cognitive resilience (n = 23), and brain resilience (n = 2). Critical examination of the literature revealed that there is considerable methodologic variability in how the residual measures were derived and validated. Despite methodologic differences across studies, meta-analytic assessments showed significant associations of levels of resistance (hazard ratio [HR] [95% confidence interval (CI)] 1.12 [1.07-1.17]; p < 0.0001) and levels of resilience (HR [95% CI] 0.46 [0.32-0.68]; p < 0.001) with risk of progression to dementia/AD. Resilience was also associated with rate of cognitive decline (β [95% CI] 0.05 [0.01-0.08]; p < 0.01). DISCUSSION: This review and meta-analysis supports the usefulness of residual methods as appropriate measures of resilience and resistance, as they capture clinically meaningful information in aging and AD. More rigorous methodologic standardization is needed to increase comparability across studies and, ultimately, application in clinical practice.
UR - http://www.scopus.com/inward/record.url?scp=85114818177&partnerID=8YFLogxK
U2 - https://doi.org/10.1212/WNL.0000000000012499
DO - https://doi.org/10.1212/WNL.0000000000012499
M3 - Comment/Letter to the editor
C2 - 34266918
SN - 0028-3878
VL - 97
SP - 474
EP - 488
JO - Neurology
JF - Neurology
IS - 10
ER -