Cognitive reserve estimated with a life experience questionnaire outperforms education in predicting performance on MoCA: Italian normative data

Normative data of neuropsychological tests typically consider the effect of demographic variables like age and education on performance. However, a broad literature has shown that, after the school age, other cognitively stimulating experiences (e.g., occupational attainment and a variety of leisure-time activities) may increase and build up cognitive reserve (CR), which is positively associated with better performance in many neuropsychological tests. With these premises, we investigated the predictive capability of education and a life-experience proxy of CR on a widely used cognitive screening, i.e., the Montreal Cognitive Assessment (MoCA). Results show that models including the more comprehensive life-experience CR proxy performed better than models including Education. Based on the results of our analyses we provide normative data and cut-offs on 440 Italian individuals aged 50-90 years, by taking into account, for the first time for the Italian population, a CR index, together with demographic variables and Education, in the calculation of regression-based norms. Accounting for life-experience CR proxies can improve the accuracy of normative data and allow a finer estimation of cognitive performance, which lead to a more tailored approach to patient assessment.