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We appreciate the interest in our research.1 In the cohort study of older persons who developed incident Alzheimer disease (AD), we found that a lower level of cognitive activity was associated with earlier age of dementia onset.1 According to the reverse-causality hypothesis, a low level of cognitive activity is not a risk factor for AD but an early sign of the disease. As a test of this hypothesis, we computed the correlations of cognitive activity at the time of study enrollment with markers of AD and related dementias from a postmortem neuropathologic examination. These correlations were not significant, which we concluded provided no support for the reverse-causality hypothesis.
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Author disclosures are available upon request (journal{at}neurology.org).
- © 2022 American Academy of Neurology
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