Adaptación argentina del Cuestionario de Reserva Cognitiva: CRC-a

Abstract

La reserva cognitiva (RC) se refiere alnivel de adaptabilidad de la cognición frentea cambios cerebrales. Varios estudios la hanconsiderado un factor de protección de laenfermedad de Alzheimer (EA). En la regiónargentina no se cuenta con un instrumentovalidado que permita medir este constructo.El objetivo del presente trabajo es adaptar elCuestionario de Reserva Cognitiva (CRC) ala población argentina, establecer puntajesde corte para determinar desde niveles bajosa superiores de RC y analizar qué variablespredicen el puntaje total de la reserva. Lasmodificaciones introducidas a la adaptaciónfueron evaluadas a través de un proceso dejuicio de expertos. Un total de 177 sujetossanos completaron el Cuestionario de ReservaCognitiva en su adaptación argentina (CRCa). Mediante la medida de cuartiles, se establecieron puntajes de corte para determinarniveles bajos, medios, altos y superiores de lareserva. Se realizó una regresión lineal paraevaluar si el sexo, la edad y la escolaridadpredicen el nivel de RC. En la adaptaciónargentina del CRC se modificaron 3 de las 8dimensiones totales y 16 de los 33 ítems totalescon respecto al cuestionario original. La mediadel puntaje total obtenido por la muestra apartir del cuestionario fue de 15.06 con DS =3.42. Puntajes menores a 13 reflejaron nivelesbajos de RC, puntajes entre 13 y 16, nivelesmedios, puntajes entre 16 y 20, niveles altos,y puntajes superiores a 20, niveles superiores.La escolaridad resultó ser la única variable depredicción del nivel de RC. Si bien se encontraron diferencias entre grupos respecto a lavariable sexo, esta no demostró ser predictiva.El CRC-a es el primer instrumento desarrollado en esta región para medir el nivel de RC.Contar con su validación abriría futuras líneasde investigaciones sobre posibles intervenciones para la prevención de enfermedades,tales como la EA.

Cognitive reserve (CR) refers to the level of adaptability of cognition after brain changes. It is based on processes that allow the activation of new synaptic connections after neurodegeneration, which permits to better withstand the consequences. This reserve is constituted by the interaction of innate individual characteristics (intrauterine or genetically determined) and the exposure to different life experiences. It begins its development in early stages of life and continues its transformation up to advances ages. The sociodemographic variables reported as the main ones to build the reserve are education, leisure activities, lifestyle, socioeconomic level and intelligence. Several studies have considered it as a protective factor for Alzheimer’s Disease (AD). Subjects with high levels of CR have lower prevalence and incidence of AD in comparison to those with low levels of reserve. CR would lead to a late onset of symptoms, despite not having any effect on the underlying pathophysiological process of the disease. The reserve would not prevent AD from developing, but it would compensate the symptoms and, therefore, delay their onset. In some cases, there is such compensation that the symptoms do not manifest. There is no validated instrument available for the Argentinian region that allows to measure this construct. The aim of this study is to adapt the Cognitive Reserve Questionnaire to the Argentinian population, to establish cut-off scores to distinguish between low, medium, high and superior levels of CR and analyze which variables could predict the total reserve score. The modifications introduced in the adaptation were evaluated through an expert judgment process. A total of 177 healthy subjects completed the Cognitive Reserve Questionnaire in its Argentinian adaptation (CRQ-a). Through the measure of quartiles, cut-off scores were established to determine low, medium, high and superior levels of the reserve. A lineal regression was made to evaluate if age, education, and sex might predict the level of CR. Three of the eight total dimensions and 16 of the 33 total items that make up the original questionnaire were modified. The mean of the total score obtained by the sample from the questionnaire was 15.06 with SD = 3.42. Scores under 13 reflected low CR levels, scores between 13 and 16 reflected medium levels, scores between 16 and 20 reflected high levels, and scores above 20 reflected superior levels. Education turned out to be the only predictor variable for the level of CR. Although differences were found between groups of different sex, this variable turned out to be not predictive. The CRQ-a is the first instrument for the Argentinian population to measure the level of the reserve. It allows to quickly explore different dimensions, considered as the most relevant for its formation. These are: formal education, courses, parents’ formal education, employment, musical training, languages, reading activity and intellectual games. In patients with AD, is particularly important to have a measure for CR to prepare interventions for those subjects whose reserve levels are perceived as low, aiming to delay and, when possible, prevent the clinical manifestation of the disease. Its validation would open future lines of research on possible interventions for the prevention of diseases such as AD.