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The Gerontologist Copyright 2007 by The Gerontological Society of America Vol. 47, No. 3, 307–322 
Cognitive Functioning in Healthy Aging:The Role of Reserve and LifestyleFactors Early in Life
Thomas Fritsch, PhD,
1
McKee J. McClendon, PhD,
2
Kathleen A. Smyth, PhD,
2,3
Alan J. Lerner, MD,
2,4
Robert P. Friedland, MD,
4,5
and Janet D. Larsen, PhD
6
Purpose: 
According to the
reserve perspective 
oncognitive aging, individuals are born with or candevelop resources that help them resist normal anddisease-related cognitive changes that occur inaging. The reserve perspective is becoming moresophisticated, but gaps in knowledge persist. In thepresent research, we considered three understudiedquestions about reserve: Is reserve primarily static(unchangeable) throughout the life course or dynamic(changeable, in terms of increases or decreases)?Can reserve be increased at any point in life, or arethere optimal time periods—such as early life, midlife,or late life—to increase it? Does participation indifferent types of leisure and occupational activities inearly life and midlife have different effects dependingon specific domains of late-life cognitive functioning?Here we link early cognitive and activity data—gathered from archival sources—with cognitive datafrom older adults to examine these issues.
Design and Methods: 
349 participants, all mid-1940s grad-uates of the same high school, underwent telephonecognitive screening. All participants provided accessto adolescent IQ scores; we determined activity levelsfrom yearbooks. We used path analysis to evaluatethe complex relationships between early life, midlife,and late-life variables.
Results: 
Adolescent IQ hadstrong direct effects on global cognitive functioning,episodic memory, verbal fluency, and processingspeed. Participants’ high school mental activities haddirect effects on verbal fluency, but physical andsocial activities did not predict any cognitive mea-sure. Education had direct effects on global cognitivefunctioning, episodic memory, and, most strongly,processing speed, but other midlife factors (notably,occupational demands) were not significant predic-tors of late-life cognition. There were weak indirecteffects of adolescent IQ on global cognitive function-ing, episodic memory, and processing speed, workingthrough high school mental activities and education.Verbal fluency, in contrast, was affected by adoles-cent IQ through links with high school mental ac-tivities, but not education.
Implications: 
Our studysuggests that reserve is dynamic, but it is mostamenable to change in early life. We conclude thatan active, engaged lifestyle, emphasizing mentalactivity and educational pursuits in early life, canhave a positive impact on cognitive functioning inlate life.
Key Words: Cognition, Reserve, IQ, Activity level 
Over the past several decades, researchers haveincreasingly devoted themselves to studying risk andprotective factors for cognitive functioning in aging.The central question has been why some individualsmaintain good cognitive functioning as they age,whereas others experience cognitive decline. A largebody of work has accumulated that describes some
This research was supported by Grant P50 AG08012 from the PilotStudy Program of the University Memory and Aging Center, CaseWestern Reserve University and University Hospitals of Cleveland, andby the American Health Assistance Foundation in Clarksburg, MD. Thesponsors had no role in the design, methods, participant recruitment,data collection, analysis, and preparation of the article.We gratefully acknowledge Elaine Ziol, MHS, CCC; KristenEmancipator, BA; Leighanne Hustak, ND, CNP; and Wendy Lemere,MSN, CNP for interviewing participants. Other research assistance andsupport was provided by Andrew Bruner; Tonia Cardwell, BA; NancyCatalani; Hildegard Fritsch, PhD; and Linda Rechlin, BA. We also thankthree anonymous reviewers for their helpful comments.Address correspondence to Thomas Fritsch, PhD, Center on Age &Community, University of Wisconsin—Milwaukee, PO Box 413,Milwaukee, WI 53201. E-mail: fritscht@uwm.edu
1
CenteronAge&Community,UniversityofWisconsin—Milwaukee.
2
University Memory and Aging Center, Cleveland, OH.
3
Department of Epidemiology and Biostatistics, Case WesternReserve University, Cleveland, OH.
4
Department of Neurology, Case Western Reserve University,Cleveland, OH.
5
Laboratory of Neurogeriatrics, Case Western Reserve University,Cleveland, OH.
6
Department of Psychology, John Carroll University, UniversityHeights, OH.
Vol. 47, No. 3, 2007 307
 
of the correlates of preserved and declining cognitivefunctioning in aging. Emerging from this empiricalwork—and now widely used to explain many find-ings in the cognitive gerontology literature—is theconcept of 
reserve
(Katzman, 1993; Satz, 1993; Stern,2002). According to the reserve perspective, impair-ments in cognition become apparent only after areserve (cognitive or neurological resources) is de-pleted to a certain threshold. Those individuals withless initial reserve are more likely to manifest clinicalimpairments because they have relatively fewer re-sources to sustain them in the face of normal anddisease-related changes that accompany aging. Incontrast, those with more initial reserve can functionlonger without manifesting clinical impairments be-cause their supply of resources is greater.Increasingly, researchers are refining their opera-tional definitions of reserve, are using reserve tomake predictions in studies, and are outlining withgreater care the general and specific aspects of thereserve perspective. For example, authors havebegun to discuss more explicitly the dynamic natureof reserve (Kliegel, Zimprich, & Rott, 2004;Richards, Hardy, & Wadsworth, 2003; Richards &Sacker, 2003; Wilson et al., 2005). That is, althoughthe initial level of reserve may be determined byinnate differences in resources at birth, or by differ-ences in cognitive activity as the brain matures inchildhood, there are processes in young adulthood,midlife, and late life that may also act to increase ordecrease reserve (Kliegel et al.). Thus, the absolutelevel of reserve may change throughout the lifecourse. This idea is consistent with several inter-related concepts that, in recent years, have emergedin the gerontology, aging, and neuroscience liter-atures. For example, the disuse perspective empha-sizes that decreases in activity patterns result inatrophy of cognitive skills and processes (Salthouse,1991). Mental activity, in contrast, in the form of educational activities, occupational demands, andmental leisure-time pursuits, increases these skills.The disuse perspective is commonly captured by thephrase, ‘‘use it or lose it,’’ an idea that has beenwidely embraced by lay audiences. Neurologists andneuroscientists have long recognized the character-istic of the brain known as ‘‘plasticity’’ (Kramer,Bherer, Colcombe, Dong, & Greenough, 2004).Plasticity refers to the brain’s ability to change andkeep itself vital. Specifically, when a person ischallenged, either by activities or environmentalconditions, neurons form new dendritic branchesand more synapses; these morphological changesenhance the brain and provide better capacities toresist insults from neurological conditions such asAlzheimer’s disease (Kramer et al.). Several studiessupport the notion that reserve is dynamic, showingthat early indicators of reserve (including childhoodIQ, young adult IQ, or early education) predictmediating variables in midlife (such as intellectualactivities or occupational status), which in turnpredict adult cognitive functioning (assessed in termsof memory, global cognitive functioning, verbal, orvisual ability; see, e.g., Arbuckle, Gold, Andres,Schwartzman, & Chaikelson, 1992; Kliegel et al.,2004; Richards et al., 2003; Richards & Sacker, 2003;Wilson et al., 2005). Importantly, however, althoughexisting studies suggest that mediating effects of factors in midlife can be found, they also seem toindicate that these relationships are relatively weak,implying that
significant 
changes in level of reservecannot be easily made. More research is needed toconfirm or refute this conclusion.If reserve is truly dynamic, a closely related butunanswered question is whether there is an optimaltime during the life course when one can intervene tomodify one’s level of reserve. If such an optimal timeexists, identifying it would have practical value,because increasing reserve could delay the clinicalmanifestations of diseases such as Alzheimer’s. Someresearch seems to indicate that reserve can bemodified in adulthood and midlife. For example, inpopulation-based studies of older adults, researchershave found that greater current involvement inmental, physical, and social leisure activities isassociated with better memory and cognitive perfor-mance (Christensen & Mackinnon, 1994; Hultsch,Hammer, & Small, 1993), and changes in adultactivity levels have been linked to changes inmemory and cognitive functioning in longitudinalanalyses (Hultsch, Small, Hertzog, & Dixon, 1999;Mackinnon, Christensen, Hofer, Korten, & Jorm,2003). Research examining the relationships betweenoccupational demands and cognition has shown thatindividuals in occupations with greater mentaldemands—including frequent decision making, self-direction, and intellectual challenge—have bettercognitive functioning, whereas those in occupationswith lower mental demands have poorer cognitivefunctioning (Kohn & Schooler, 1978; Schooler &Mulatu, 2001).However, evidence from a few recent studies thatmeasured participation in activities and level of reserve throughout the life course seems to suggestthat changing one’s reserve level can better beaccomplished
early in life.
In two different reports(Kliegel et al., 2004; Richards & Sacker, 2003),research teams examined associations of early re-serve, midlife mediating variables, and adult lifestylefactors with adult cognitive functioning. Resultsshowed strong direct effects of early-life factors(childhood IQ and early education) on late-lifecognitive functioning, but effects of midlife factorssuch as occupation were not significant. Otherstudies show that early activities and IQ contributeto cognitive functioning in late life principallythrough associations with late-life activities andlate-life IQ (Arbuckle et al., 1992; Wilson et al.,2005). Together, these studies support the importantrole (either direct or indirect) of early-life factors inlate-life cognition.
308 The Gerontologist
 
Authors have suggested that different aspects of cognitive functioning might respond in differentways to different social influences throughout the lifespan (Richards & Deary, 2005; Wilson et al., 2005).For example, one might predict that education andleisure and occupational activities requiring mentalengagement would be strong predictors of abilitiesreflecting the products of education and mental acti-vity, such as measures of general knowledge, vocab-ulary, and verbal abilities. In contrast, physicalactivities might enhance cognition in late life becausephysical activity enhances cerebral blood flood andoxygenation, which might slow processes linked tobiological aging (e.g., accumulation of amyloiddeposits, neurofibrillary tangles, and cerebral in-farctions, over time, in the brain; see Friedland,1993). Thus, physical activities might more stronglyinfluence abilities reflecting the extent or degree of biological aging, such as processing speed, workingmemory, and attention. The effects of social acti-vities on different domains of cognitive functioningare more difficult to predict. Some researchers havesuggested that social activities may provide pro-tection through a psychoneuroimmunological mech-anism (Kiecolt-Glaser, McGuire, Robles, & Glaser,2002). For example, social support is known tobuffer against stress, which could result in thedecreased production of cortisol. Consistently lowercortisol levels have been associated with better epi-sodic memory performance (Hibber, Yau, & Seckl,2000), but strong links to other domains of cognitivefunctioning have not been established as readily.Thus, involvement in social activities may predictmemory better than other domains of cognition;however, the magnitude of the relationship would beweaker than that between education and mentalactivities, where there is a more proximal link be-tween the type of activity (education) and the cog-nitive outcome (memory).Nevertheless on the basis of our review, we couldidentify no single empirical study that examined theimpact of participating in different types of activities(mental, social, and physical) in early life and midlifeon specific domains of cognitive functioning in latelife. Studies either assessed different domains of cognitive functioning in adulthood but did not mea-sure different activity patterns in early life or midlife,such as the studies by Richards and Sacker (2003)and Wilson and colleagues (2005), or they measuredparticipation in different activities in midlife andonly assessed a single domain of cognitive function-ing in late life, such as the study by Richards andcolleagues (2003). Specifically, in the report byWilson and colleagues, early cognitive activity andavailable cognitive resources in the home (such asnewspapers and magazines) more strongly predictedsemantic memory than perceptual speed, episodicmemory, working memory, and visuospatial skill.In the report by Richards and Sacker, a measureof childhood IQ strongly predicted a measure of accumulated knowledge (NART) and verbal mem-ory assessed in late life, but childhood IQ onlyweakly predicted visual search ability. In the re-search reported by Richards and colleagues, a per-son’s physical activities and spare-time activities(including both mental and social activities) at age 36predicted verbal memory at age 43. Furthermore,physical activities predicted change in memory fromages 43 to 53, but spare-time activities did not.Finally, Aartsen, Smits, van Tilburg, Knipscheer, andDeeg (2002) studied the lagged effects of three typesof activities (social, experiential, and developmental)on several domains of cognitive functioning (mem-ory, learning, fluid intelligence, processing speed,and global cognitive functioning) in a sample of older adults with a mean age of 69 years at a baselineassessment. None of the activities in which respond-ents participated at baseline had effects on anydomain of cognitive functioning assessed 6 yearslater. However, faster processing speed at baselinewas shown to predict greater involvement in de-velopmental activities 6 years later. These studiesclearly show that there is a need for research thatexamines associations of mental, social, and physicalactivities in early life and midlife with differentdomains of cognitive functioning in late life.Thus, although a few studies have specificallyaddressed some relevant gaps in our ability to modelthe reserve process, further work is needed. In thepresent study, our goals were as follows: (a) toexamine in more detail the nature of reserve byconsidering whether it is primarily dynamic or static;(b) to consider whether reserve can be increasedthroughout the life course, or whether there arespecific periods during which attempts to modifyreserve level should be made; and (c) to investigatewhether participation in different types of activitiesin early life and midlife has different effects oncognitive aging, depending on the specific cognitivedomain studied. Our study is an improvement overprevious efforts, because we consider these questionsin a single investigation; use strong measures of activity levels and engagement throughout life (highschool extracurricular activities and occupationaldemands) that were directly assessed without re-liance on proxy respondents; and have good controlfor extraneous variables because we recruited allparticipants from the same population (i.e., gradu-ates of the same high school). On the basis of theoryand results from previous research, we made thefollowing hypotheses. First, early IQ will predictlate-life cognitive functioning both directly andindirectly through midlife mediating variables, in-dicating that reserve is dynamic. Second, factors inearly life will be stronger predictors of cognition inlate life than will factors in midlife and beyond.Third, specific activities and pursuits in early life willpredict some domains of late-life cognitive function-ing more strongly than other domains (e.g., educa-tion and mental activities in high school will more
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