To evaluate the impact of occupational complexity on rate of cognitive and functional decline in behavioral variant frontotemporal degeneration (bvFTD).

bvFTD is a common form of young-onset dementia characterized by impaired social and executive function. Cognitive reserve (CR) theory posits that factors such as mentally challenging activities protect against cognitive decline, however this has not been tested in bvFTD. We hypothesized that working in mentally challenging occupations will be related to slower longitudinal cognitive and functional change in bvFTD.

34 patients diagnosed with bvFTD using clinical consensus criteria (Age at Baseline Testing: M=61.97(8.58); Male=21; Â鶹´«Ã½Ó³»­: M=16.24(2.66); Baseline MMSE: M=24.59(3.80)) were examined longitudinally on the Clinical Dementia Rating (CDR), a measure of functional impairment, and the National Alzheimer’s Coordinating Center Uniform Data Set and FTLD Module neuropsychological battery (number of visits: M=2.85(1.42)). Composite scores of cognitive complexity and physical demands of main lifetime occupation were calculated using the Occupational Information Network (O*NET) database. Linear mixed effects models were used to derive an annualized slope of decline for each individual, covarying for age, sex, education and disease duration. Linear models were then used to examine the relationship between slope of annualized decline and O*NET scores.

Higher occupational cognitive complexity was associated with a slower decline in CDR (p=0.03) and executive function (category-naming fluency: p<0.001; letter-guided fluency: p=0.06), while physical composite scores were not significantly related to any cognitive domain.

Higher occupational cognitive complexity is associated with a slower rate of functional impairment as well as a slower decline in executive functioning in bvFTD. These findings suggest that working in mentally challenging occupations contributes to CR which protects against cognitive and functional impairments characteristic of bvFTD.