Relationship Between Motor Reserve, General Cognitive Functioning and Brain Atrophy In Older Adults

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Brain atrophy is strongly associated with cognitive decline that could progress further to dementia. Motor reserve, a cumulative experience of physical activity throughout life, has been identified as a potential protective factor against cognitive decline. This study aimed to investigate the relationship between motor reserve, general cognitive function and brain atrophy in older adults with previously no reported cognitive impairment. All participants underwent detailed assessment of their lifestyle and psychological status, as well as structural magnetic resonance imaging for volumetric brain data. Visual rating scales (Global Cognitive Atrophy scale, Medial Temporal Atrophy scale, Parietal Atrophy scale, Entorhinal Cortex Atrophy, and Frontotemporal Atrophy scale) were used to grade the level of brain atrophy. Montreal Cognitive Assessment screening task was performed to evaluate global cognitive functioning in all subjects. 54 older adults (18.5% men) aged from 65 to 85 ( M = 71.44 years, SD = 5.01 years) were included in the study. The study results showed a tendency towards the relationship between several cortical atrophy scales and the motor reserve; nevertheless, after controlling for global cognition, motor reserve was associated only with ERICA score in the left hemisphere and whole brain, and parietal atrophy score in the left hemisphere. The results suggest that individuals with higher motor reserve scores may be less likely to experience brain atrophy in the entorhinal, medial-temporal and parietal cortices; however, due to the small sample, the results should be interpreted with caution. Health sciences/Diseases Health sciences/Neurology Biological sciences/Neuroscience brain atrophy motor reserve global cognitive functioning older adults Figures Figure 1 Figure 2 Background Although the first evidence of neurodegenerative diseases was recorded already in the early 19th century [ 1 ], today the incidence and prevalence of the disease continue to rise, with World Health Organization (WHO) predicting that between 2020 and 2050, the number of people with dementia is expected to increase from 55 million to 139 million [ 2 ]. Given the important role of age in the development of neurodegenerative diseases [ 3 ], the annual increase in the ageing population and the enormous socioeconomic impact of neurodegenerative diseases [ 4 ], it is important to identify factors and lifestyle interventions that contribute to and slow the progression of the disease. Some studies have shown the effectiveness of prevention. Disease prevention aims to reduce the likelihood of neurodegenerative diseases occurring before its biological manifestation [ 5 ]. In this specific topic it is important to distinguish modifiable and nonmodifiable risk factors. The nonmodifiable are age, sex, hereditary physical characteristics and the APOE-4 gene, while modifiable include lifestyle-related factors such as education level, obesity, hypertension, and physical activity [ 6 , 7 ]. There are also studies which have shown the positive effects of physical activity on cognitive performance and prevention of neurodegenerative diseases [ 8 , 9 ]. Physical activity is any bodily movement caused by the contraction of skeletal muscles resulting in energy expenditure [ 10 ] and is well known as a preventive measure for several diseases, such as cardiovascular disease, cancer, and psychiatric disorders [ 11 , 12 ]. The importance of physical activity increased when the links of aerobic physical activity with the brain cortex and various brain structures such as the hippocampus [ 13 ], the amygdala [ 14 ], the thalamus were identified and described. What is more, the study of Marques-Aleixo et al. provides a detailed analysis of the positive impact of physical activity on brain cortex and cerebellum mitochondrial functioning. Specific study findings confirmed that physical activity, that is, endurance treadmill training and voluntary free-wheel activity, improved mitochondrial respiratory activity and decreased markers of oxidative stress in both brain subareas [ 15 ]. These results are in line with the pilot study by Bashir et al. who highlighted enhancing abilities of physical activities on cortical size [ 16 ]. The results of at least two studies conducted in the past decade confirm that physical activity could have a positive impact on cognitive function in ageing, delaying the development and progression of Alzheimer's disease [ 17 , 18 ]. Furthermore, several prospective cohort studies show that older people who participated in 150 min per week of moderate physical activity in the previous 5 or more years have a 40% lower risk of developing Alzheimer's disease than sedentary individuals [ 19 , 20 ]. Although the findings from studies indicate that short-term increases in physical activity and exercise can be beneficial to cognitive and brain health, there is still a lack of evidence of the neuroprotective effects of long-term physical activity in older people. In 2018, a group of American researchers investigated the effects of physical activity on cognitive appraisal and brain structure and came up with desirable results suggesting positive effects [ 21 ]. However, the research results are retrospective and do not depict a cause-effect relationship between the variables. As motor reserve remains a relatively unknown term and most studies on the relationship of physical activity with cognitive assessment have focused on short-term physical activity interventions, the aim of this article is to explore the associations between motor reserve, general cognitive function and brain atrophy in older adults [ 22 ]. Methods Information of age, gender, native language, education and living status was obtained using the sociodemographic questionnaire. All participants had at least secondary school education ( M years of education = 15.41, SD = 3.53) and were living independently at the time of assessment and had no significant memory complaints, no known diagnosis of dementia, cardiovascular, metabolic, pulmonary, respiratory, rheumatological, oncological, psychiatric, or other chronic diseases that could limit physical their participation in the study [ 23 ]. Two recruitment strategies were used. To ensure the variability of the physical activity of the participants, professional veteran and grassroot sports associations were contacted. A public announcement for recruitment was also published in mass media. Before receiving the invitation to the study, each participant received a short clinical interview to assess the compliance with the inclusion criteria. Global cognitive assessment To control for the general cognition, The Montreal Cognitive Assessment 7.1 (MoCA) was used [ 24 ]. The MoCA test is a screening tool used for general assessment of the symptoms of dementia and mild cognitive impairment and was administered by trained psychologists. Motor reserve The MR index was calculated based on the total number of years participants engaged in aerobic exercise. Specifically, the reported years of regular physical activity were divided by the number of mature life years, which was defined as 15 years, in line with the relevant cultural context (see Fig. 1.). A higher MR index score would reflect a higher motor reserve. MRI measures The images were obtained with the Siemens 1.5 Tesla Avanto magnetic resonance imaging (MRI) machine (Siemens, Erlangen, Germany). High-resolution anatomical images were obtained using a three-dimensional T1 weight magnetization prepared rapid Acquisition Gradient Echo (MPRAGE) sequence [TR = 1160 ms, TE = 4.44 ms; inversion recovery time (TI) = 600 ms; field of view, 230x230 mm 2 ; matrix size 256 x 256; flip angle θ = 15 degrees; voxel dimensions, 0.9 x 0.9 mm 3 ; acquisition time, 5 min]. Brain atrophy calculations For grading the participant’s level of brain atrophy, 6 visual rating scales - Global Cognitive Atrophy scale (GCA), Medial Temporal Atrophy scale (MTA), Parietal Atrophy scale (PAS), Entorhinal Cortex Atrophy (ERICA) and Frontotemporal Atrophy scale (FTAS) - were used. Rating was performed by a radiology resident and triangulated by a certified radiologist with European Diploma in Radiology (EDiR) certificate and with at least 10 years of experience in neuroradiology. Global Cortical Atrophy scale is the mean score for cortical atrophy throughout the complete cerebrum. The severity of GCA was graded using the four-point scale, where: 0 points - no cortical atrophy, 1 point - mild atrophy with sulcal widening, 2 points - moderate atrophy with sulcal widening and mild loss of volume, 3 points - sulcal widening and severe loss of volume [ 25 ]. Medial Temporal Atrophy obtained based on visual rating of coronal T1-weighted MRI images, where width of the choroid fissure, width of the temporal horn, and height of the hippocampal formation are assessed. The severity of MTA on coronal MRI sections were judged on a scale of 0–4, based on standard images [ 26 ]. The score is determined by visually assessing the choroid fissure width, the temporal horn width, and the hippocampal formation height, where: Grade 0 - no atrophy, Grade 1 - only widening of choroid fissure, Grade 2 - also widening of temporal horn of lateral ventricle, Grade 3 - moderate loss of hippocampal volume (decrease in height), Grade 4 - severe volume loss of hippocampus [ 25 ]. Parietal Atrophy scale is based on quantitative scoring of atrophy in three parietal structures through the whole range of parietal lobes (precuneus, sulcus cingularis posterior and parietal gyri) on T1-weighted MRI in sagittal, coronal and axial planes. PAS on both sides were rated on a scale of 0–3, where: Grade 0 – no cortical atrophy, no widening of the sulci, Grade 1 – slight atrophy of the parietal lobe, slight enlargement of the sulci in the posterior cingulum and the parieto-occipital lobes, Grade 2 – marked atrophy of the parietal lobe, widening of sulci in the posterior cingulum and parieto-occipital lobes, Grade 3 – marked atrophy with a 'knife-blade' atrophy pattern, marked widening of the sulci in the posterior cingulum and parieto-occipital lobes [ 27 , 28 ]. Entorhinal Cortex Atrophy score was obtained on thin slice T1-weighted MRI Coronal images at right angles to the long axis of the hippocampus and assessed at the level of the mammillary bodies. The ERICA scale ranges from 0 (no atrophy) to 3 (severe atrophy) with higher values indicating a higher degree of atrophy based on evaluation of the entorhinal cortex for volume loss: Grade 0 – no atrophy, normal entorhinal cortex, Grade 1 – slight atrophy and enlargement of the collateral fissure, Grade 2 – moderate atrophy with separation of the entorhinal cortex from the tentorium cerebelli, Grade 3 – severe atrophy with atrophy of the parahippocampal cortex, wide gap between the tentorium cerebelli and the entorhinal cortex [ 28 , 30 ]. Frontotemporal Atrophy scale was obtained on thin slice T1-weighted MRI Coronal images at the slice through the temporal pole just anterior to where the ‘temporal stem’ connects frontal and temporal lobes and the slice showing the lateral geniculate nuclei. The severity of the FTAS was judged on a scale of 0–5 from “normal cortical atrophy” to “severe cortical atrophy” [ 31 ]. Procedure Data were collected separately for each participant. Prior to admission in the study all participants were interviewed and their medical history was assessed. Participants who met the inclusion criteria were invited to take part in the study. All data were obtained with each participant individually. Statistical analysis was performed using IBM SPSS Statistics 29. In the first step, data screening was performed, during which no data adjustments were applied and no missing data points were present. To determine the relationship between the motor reserve, general cognitive abilities and brain atrophy, Spearman’s Rank-Order Correlation and Hierarchical Regression Analysis controlling for age was used. Informed consent was obtained from all subjects and/or their legal guardian(s). All methods used in study were carried out in accordance with Rīga Stradiņš University and Latvian Academy of Sport Education scientific guidelines and regulations. Ethical approvals (No. 1/19-05-30 and No. 01-29.1.2/1480) were obtained from the Central Medical Ethics Committee. The study was funded by a research and development grant (No. RSU-PAG-2024/1–0014) under Riga Stradins University's internal grant scheme and external consolidation with the Latvian Academy of Sport Education. Results Descriptive statistics 54 older adults with no self-reported significant neurological, ongoing oncological etc. disorders that might limit their participation in the research, aged from 65 to 85 ( M = 71.44 years, SD = 5.01 years) were included in the study. For all of the scales, the 25th percentile included only study participants without specific brain part atrophy. Moreover, for all of the scales, except Medial Temporal atrophy scale, the 75th percentile included adults with at least 1st degree specific brain part atrophy. For Global Cortical atrophy scale, left hemisphere Entorhinal Cortex Atrophy scale and left hemisphere Frontotemporal Atrophy scale mode values described 1st degree specific brain part atrophy. Correlation analysis Spearman’s rank-order correlation with Bootstrapping revealed a negative significant correlation between the motor reserve score and Entorhinal Cortex Atrophy scale score in the left hemisphere ( r s = − .451, p = < .001), as well with the whole brain Entorhinal Cortex Atrophy scale score ( r s = − .417, p = .002), and with the Parietal Atrophy scale score in the left hemisphere ( r s = − .355, p = .008) (see full correlation matrix in Table 1 ) Table 1 The Spearman’s Rank-Order Correlation between Motor Reserve and the Atrophy measurement scales (Entorhinal Cortex Atrophy scale, Parietal Atrophy scale, Medial Temporal scale and Frontotemporal Atrophy scale). Variable r s CI SE p Left hemisphere ERICA − .451 − .664; − .186 .121 < .001 Right hemisphere ERICA − .324 − .563; − .067 .124 .017 Whole brain ERICA − .417 − .634; − .146 .124 .002 Left hemisphere PAS − .355 − .584; − .090 .124 .008 Right hemisphere PAS − .301 − .544; − .032 .127 .027 Whole brain PAS − .332 − .565; − .073 .124 .014 Left Hemisphere MTA − .095 − .362; .185 .126 .495 Right hemisphere MTA .020 − .256; .294 .130 .883 Whole brain MTA − .064 − .333; .215 .128 .646 Left hemisphere FTA − .325 − .553; − .058 .125 .017 Right hemisphere FTA − .198 − .460; .094 .134 .150 Whole brain FTA − .276 − .504; .009 .129 .044 Table 2 Motor Reserve and Atrophy scale Confidence Intervals of Spearman's rho. The Spearman’s Rank-Order Correlation between Motor Reserve and Atrophy scales used in the research. Variable SE (1.) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12 13. 1. Motor Reserve 2. Left ERICA .121 − .451** 3. Right ERICA .124 − .324* 4. Whole ERICA .124 − .417** 5. Left PAS .124 − .355** .244 .363** .323* 6. Right PAS .127 − .301* .179 .305* .263 7. Whole PAS .124 − .332* .208 .345* .296* 8. Left MTA .126 − .095 .539** .585** .592** .141 .069 .115 9. Right MTA .130 .020 .205 .258 .236 − .035 .017 − .007 10. Whole MTA .128 − .064 .432** .457** .466** .070 .027 .056 11. Left FTA .125 − .325* .780** .751** .818** .253 .171 .219 .616** .361** .576** 12. Right FTA .134 − .198 .655* .761** .750** .303* .245 .280* .648** .302* .561** 13. Whole FTA .129 − .276* 758** .793** .826** .290* .214 .259 .674** .370** .610** * p < .05; ** p < .01. SE - Standard Error Regression analysis Hierarchical regression analysis, controlling for age and global cognitive abilities (MoCA) showed that motor reserve explained 10.9% of the variation in the left hemisphere ERICA score ( R 2 = .281, RΔ = .109, p < .001), but for the whole brain ERICA score motor reserve explained 8.4% of the variation ( R 2 = .296, RΔ = .084, p = .018) (see Table 3 ). What is more, from Parietal Atrophy scale scores only for the left hemisphere it showed that motor reserve proved a significant 7.1% change of the variation ( R 2 = .169, RΔ = .071, p < .050). Right hemisphere’s score showed that there is not any relation to motor reserve ( R 2 = .214, RΔ = .036, p = .138) and there was a lower whole brain score ( R 2 = .200, RΔ = .055, p = .069) compared to the left hemisphere. There were not any statistically significant associations between Frontotemporal Atrophy scale scores (left hemisphere and whole brain) and motor reserve variations ( p = .104 and p = .170 respectively) (see Table 3 ). Table 3 Relationship between age, cognitive abilities (MoCA) and motor reserve with specific brain part atrophy. Dependent variable R² ΔR² B SE B β F p Right hemisphere PA scale .214 .036 − .458 .304 − .193 4.526 .138 Left hemisphere PA scale .169 .071 − .644 .312 − .272 3.384 .044 Whole brain PA scale .200 .055 − .551 .296 − .240 4.160 .069 Left hemisphere FTA scale .311 .038 − .498 .301 − .198 7.538 .104 Whole brain FTA scale .269 .028 − .389 .279 − .172 6.140 .170 Left hemisphere ERICA score .281 .109 − .816 .297 − .336 6.527 < .001 Whole brain ERICA score .296 .084 − .637 .261 − .295 6.996 .018 *PA - Parietal Atrophy scale scores (Linear regression analysis) *FTA - Frontotemporal Atrophy scale scores (Linear regression analysis) The datasets generated and/or analysed during the current study are available in the Rīga Stradiņš University Institutional Repository Dataverse, V1, https://doi.org/10.48510/FK2/JCFJZL [ 23 ]. Discussion This study aimed to investigate the relationship between motor reserve and brain atrophy in older adults. Our study highlights the significance of motor reserve (long-term physical activity) as a potential factor in delaying cognitive decline, especially in medial temporal and parietal regions. In the last three decades, there has been discussion about the effect of physical exercise on brain and cognitive health. Regular exercise has been associated with a delay in the onset of Alzheimer’s disease (AD) [ 32 ]. Moreover, some studies have found evidence that moderate intensity physical activity has a positive effect on the brain's cortex structure [ 9 , 33 ]. Several articles support the relationship between higher physical activity and slower structural brain shrinkage [ 34 , 35 ]. In cognitively healthy older adults without memory complaints or chronic diseases, greater entorhinal cortex atrophy measured via visual rating scales has been significantly associated with reduced motor reserve, indicating that even subtle degeneration in this early-affected memory region can impair motor resilience [ 36 ]. Similarly, elevated Parietal Atrophy Scale (PAS) scores, reflecting structural decline in parietal regions responsible for visuomotor integration, also correlate with diminished motor performance in elderly cohorts [ 37 ]. Longitudinal evidence further shows that entorhinal atrophy rates significantly predict future cognitive decline, underscoring vulnerability even in individuals with prevailing intact cognition [ 38 ]. Another prospective study demonstrated that overall brain atrophy—as measured by CT—predicted poorer performance on complex motor tasks, supporting a broader connection between cortical loss and motor decline even before dementia onset [ 39 ]. Likewise, greater parietal cortex atrophy has been correlated with decreased manual dexterity and gait speed in aging populations, highlighting how structural decline in this region may undermine motor reserve and physical capacity [ 40 ]. These findings collectively underscore that, among older adults without clinical impairment, visual rating scales such as ERICA and PAS can reveal subtle neuroanatomical changes that meaningfully relate to reductions in motor reserve and may serve as early markers for cognitive–motor vulnerability. A research from Simon Fraser University emphasised the difficulty of distinguishing frontotemporal dementia from Alzheimer’s disease. Despite a vast list of methods and screening tools, MRI visual assessment remains the primary method of scan interpretation [ 41 ]. Frontotemporal dementia is believed to be the second most common kind of degenerative dementia, however, the early presentation of the frontal type typically comprises non cognitive behavioural domains and personality alterations, which might dominate the clinical picture for a long time before actual cognitive decline manifests [ 42 ]. Similar to the aforementioned study, Tward et al. suggested that measuring entorhinal atrophy at the population level might help determine the efficiency of disease-modifying interventions before cognitive impairments arise [ 43 ]. However, it is important to note that numerous cognitive subtests were not significantly related to brain atrophy scales, making it uncertain which region of the brain may be affected by exact cognitive decline. Ageing often brings changes in cognitive tasks, requiring more time and mental abilities to complete. Memory and executive functioning, in particular, deteriorate throughout the preclinical case and are the cognitive domains most associated with Alzheimer’s progression [ 44 ]. Future longitudinal studies are needed to assess changes in brain atrophy and global cognitive functioning by MR level to better elucidate causality and directionality of observed associations. Although our sample size was sufficient to test our primary aims, we may have been underpowered when examining the three-way interactions; more data could show some differences in correlation between variables. Secondly, since our sample consisted only of healthy Latvian participants, with female gender representing the greater part of the study, our findings cannot be generalised to a socioeconomically diverse population. What is more, Visual rating scales (VRS) used to assess MRI-detected brain atrophy are limited by observer bias and inter-rater variability, which can significantly impact consistency and diagnostic accuracy. A study by Schmuck et al. reported poor agreement between visual ratings and volumetric software, and concluded that VRS tends to underestimate atrophy [ 45 ]. Furthermore, these scales have limited sensitivity for detecting subtle or early atrophic changes due to their coarse ordinal structure [ 46 ]. Another study emphasized that VRS are age-dependent and less effective in older adults, with reduced discrimination between normal aging and pathological atrophy in participants over 75 years old [ 47 ]. A key limitation of the study is the reliance on self-reported health status, which is vulnerable to response bias, as participants may overestimate or underestimate their actual health due to social desirability or recall inaccuracies [ 48 ]. While the authors recognize that the results of the inferential tests could emerge as significant by chance (i.e., Type I error or “false positive”), we opted to not to apply Bonferroni correction, as in smaller samples it may increase a risk of Type II error, namely, “false negative” e.g. [ 49 ]. The authors acknowledge that the sample size poses some limitations; nonetheless, it is important to highlight that the overall findings align well with those of other independent studies. These limitations should be considered against the novelty of the study, including an at-risk group, objectively recorded physical activity, and an investigation of brain atrophy and global cognitive functioning over a key period of ageing. Conclusions Our study provides evidence that greater MR could be associated with a lower rate of parietal and entorhinal atrophy and, consequently, a lower chance of developing cognitive decline symptoms or dementia. In particular, these rates were most pronounced in adults who were assessed for the level of MR as low. Besides, our findings support previous research indicating the significance of the association between cognitive functions and brain structural changes in older adults. There is still no single distinctive exercise approach that can be suggested to preserve cognitive function at all stages of life. Further studies are needed to understand the best level of activity required for brain health, as well as to determine whether there is an optimal time of life to intervene to improve physical activity in people who are not already physically active. Abbreviations ERICA Entorhinal Cortex Atrophy Scale FTA Frontotemporal Atrophy Scale GCA Global Cognitive Atrophy Scale MoCA Montreal Cognitive Assessment MPRAGE Magnetization Prepared Rapid Acquisition Gradient Echo MRI Magnetic Resonance Imaging MR Motor Reserve MTA Medial Temporal Atrophy Scale PAS Parietal Atrophy Scale PPA Primary Progressive Aphasia TE Echo Time TI Inversion Recovery Time TR Repetition Time VRS Visual Rating Scale WHO World Health Organization Declarations Author Contribution K.Š., N.Z., K.K., A.S., R.N. did the conceptualization of the research. K.K., K.Š., N.Z. wrote the main manuscript text; Review and editing of the manuscript by K.K., K.Š., N.Z., A.S., R.N.; Methodology was chosen by K.Š., N.Z., K.K., A.S.; Figures, visualisation and data analysis created by K.K., K.Š.; Software was implemented and used by K.K.; Validation of the gathered data was performed by K.Š., N.Z.; Formal analysis by N.Z., K.Š., A.S.; Investigation of the research by N.Z., K.Š., A.S.; Resources by A.S., N.Z., K.Š., A.P.; Data curation by R.N., K.Š., N.Z.; Research supervision by K.Š., N.Z., A.S., A.P.; Project administration A.S., N.Z.; Funding acquisition by A.S., N.Z. All authors reviewed the manuscript.This study was carried out within the State Research Project Modifiable Bio and Life-Style Markers in Predicting Cognitive Decline, MOBILE-COG) (Nr. RSU-PAG-2024/1-0014), and State Research Programme BIOMEDICINE, sub-project No. 5.8.2. “Establishing the Net Attainable Benefits of Long-term Exercise”. 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Using visual rating to diagnose dementia: a critical evaluation of MRI atrophy scales. J. Neurol. Neurosurg. Psychiatry . 86 , 1225–1233. https://doi.org/10.1136/jnnp-2014-310090 (2015). Wang, M., Zhang, H., Liang, J., Huang, J. & Chen, N. Exercise suppresses neuroinflammation for alleviating Alzheimer’s disease. J. Neuroinflamm. 20 , 76. https://doi.org/10.1186/s12974-023-02753-6 (2023). Reiter, K. et al. Improved Cardiorespiratory Fitness Is Associated with Increased Cortical Thickness in Mild Cognitive Impairment. J. Int. Neuropsychol. Soc. 21 , 757–767. https://doi.org/10.1017/S135561771500079X (2015). Wanigatunga, A. A. et al. Association Between Brain Volumes and Patterns of Physical Activity in Community-Dwelling Older Adults. Journals Gerontology: Ser. A . 76 , 1504–1511. https://doi.org/10.1093/gerona/glaa294 (2021). Festa, F., Medori, S. & Macrì, M. Move Your Body, Boost Your Brain: The Positive Impact of Physical Activity on Cognition across All Age Groups. Biomedicines 11 , 1765. https://doi.org/10.3390/biomedicines11061765 (2023). Du, A-T. et al. Age effects on atrophy rates of entorhinal cortex and hippocampus. Neurobiol. Aging . 27 , 733–740. https://doi.org/10.1016/j.neurobiolaging.2005.03.021 (2006). Guo, X. et al. A Population-Based Study on Brain Atrophy and Motor Performance in Elderly Women. Journals Gerontology: Ser. A . 56 , M633–M637. https://doi.org/10.1093/gerona/56.10.M633 (2001). Rodrigue, K. M. & Raz, N. Shrinkage of the Entorhinal Cortex over Five Years Predicts Memory Performance in Healthy Adults. J. Neurosci. 24 , 956–963. https://doi.org/10.1523/JNEUROSCI.4166-03.2004 (2004). Tian, Q. et al. A prospective study of focal brain atrophy, mobility and fitness. J. Intern. Med. 286 , 88–100. https://doi.org/10.1111/joim.12894 (2019). Yu, J. H. et al. Sarcopenia is associated with decreased gray matter volume in the parietal lobe: a longitudinal cohort study. BMC Geriatr. 21 , 622. https://doi.org/10.1186/s12877-021-02581-4 (2021). Ma, D. et al. Differential Diagnosis of Frontotemporal Dementia, Alzheimer’s Disease, and Normal Aging Using a Multi-Scale Multi-Type Feature Generative Adversarial Deep Neural Network on Structural Magnetic Resonance Images. Front. Neurosci. 14. https://doi.org/10.3389/fnins.2020.00853 (2020). Leroy, M. et al. Characteristics and progression of patients with frontotemporal dementia in a regional memory clinic network. Alzheimer’s Res. Therapy . 13 , 19. https://doi.org/10.1186/s13195-020-00753-9 (2021). Tward, D. J. et al. Entorhinal and transentorhinal atrophy in mild cognitive impairment using longitudinal diffeomorphometry. Alzheimer’s Dementia: Diagnosis Assess. Disease Monit. 9 , 41–50. https://doi.org/10.1016/j.dadm.2017.07.005 (2017). Murman, D. L. The Impact of Age on Cognition. Semin. Hear. 36 , 111–121. https://doi.org/10.1055/s-0035-1555115 (2015). Bruno, F. et al. Radiological Reporting of Brain Atrophy in MRI: Real-Life Comparison Between Narrative Reports, Semiquantitative Scales and Automated Software-Based Volumetry. Diagnostics 15 , 1246. https://doi.org/10.3390/diagnostics15101246 (2025). Buchert, R. Visual rating of brain atrophy in structural MRI: Is its time over? Eur. Radiol. 35 , 4243–4245. https://doi.org/10.1007/s00330-025-11424-4 (2025). Rhodius-Meester, H. F. M. et al. MRI Visual Ratings of Brain Atrophy and White Matter Hyperintensities across the Spectrum of Cognitive Decline Are Differently Affected by Age and Diagnosis. Front. Aging Neurosci. 9. https://doi.org/10.3389/fnagi.2017.00117 (2017). Cuevas, H., Danesh, V. & Henneghan, A. Self-Reported Cognitive Function in Persons with Nonneurological Chronic Diseases: A Systematic Review. J. Aging Res. 2022;2022:5803337. https://doi.org/10.1155/2022/5803337 Armstrong, R. A. When to use the Bonferroni correction. Ophthalmic Physiol. Opt. 34 , 502–508. https://doi.org/10.1111/opo.12131 (2014). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 10 Oct, 2025 Reviews received at journal 09 Oct, 2025 Reviews received at journal 09 Oct, 2025 Reviews received at journal 30 Sep, 2025 Reviews received at journal 28 Sep, 2025 Reviewers agreed at journal 18 Sep, 2025 Reviewers agreed at journal 18 Sep, 2025 Reviewers agreed at journal 15 Sep, 2025 Reviewers agreed at journal 15 Sep, 2025 Reviewers invited by journal 15 Sep, 2025 Editor assigned by journal 15 Sep, 2025 Editor invited by journal 15 Sep, 2025 Submission checks completed at journal 11 Sep, 2025 First submitted to journal 11 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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06:24:30","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":144504,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7507706/v1/81cbb0348f413039422d713a.html"},{"id":92230930,"identity":"d6f02ebb-9811-44d0-9e6a-db4576bcbfb4","added_by":"auto","created_at":"2025-09-26 06:24:30","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":11749,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eMotor reserve calculation formula\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7507706/v1/a90d8b26d0a2ca2062abbfdc.jpg"},{"id":92230929,"identity":"7620bad5-f8da-4801-a407-45a9d1f5f2eb","added_by":"auto","created_at":"2025-09-26 06:24:30","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":339129,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eMedial Temporal Atrophy,\u003c/em\u003e \u003cem\u003eGlobal Cortical Atrophy and Parietal Atrophy scale grade visualisation \u003c/em\u003e\u003ca href=\"https://www.zotero.org/google-docs/?5wzR8n\"\u003e[29]\u003c/a\u003e\u003cem\u003e.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7507706/v1/9b512271ecafa1439e246ed1.png"},{"id":92230952,"identity":"d1f4915d-91e9-46e3-9ab3-34e0a52ed014","added_by":"auto","created_at":"2025-09-26 06:24:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1273225,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7507706/v1/9670e5ce-aa97-4171-8b53-5c31e97b9cd9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Relationship Between Motor Reserve, General Cognitive Functioning and Brain Atrophy In Older Adults","fulltext":[{"header":"Background","content":"\u003cp\u003eAlthough the first evidence of neurodegenerative diseases was recorded already in the early 19th century [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], today the incidence and prevalence of the disease continue to rise, with World Health Organization (WHO) predicting that between 2020 and 2050, the number of people with dementia is expected to increase from 55\u0026nbsp;million to 139\u0026nbsp;million [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Given the important role of age in the development of neurodegenerative diseases [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], the annual increase in the ageing population and the enormous socioeconomic impact of neurodegenerative diseases [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], it is important to identify factors and lifestyle interventions that contribute to and slow the progression of the disease.\u003c/p\u003e\u003cp\u003eSome studies have shown the effectiveness of prevention. Disease prevention aims to reduce the likelihood of neurodegenerative diseases occurring before its biological manifestation [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In this specific topic it is important to distinguish modifiable and nonmodifiable risk factors. The nonmodifiable are age, sex, hereditary physical characteristics and the APOE-4 gene, while modifiable include lifestyle-related factors such as education level, obesity, hypertension, and physical activity [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThere are also studies which have shown the positive effects of physical activity on cognitive performance and prevention of neurodegenerative diseases [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Physical activity is any bodily movement caused by the contraction of skeletal muscles resulting in energy expenditure [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] and is well known as a preventive measure for several diseases, such as cardiovascular disease, cancer, and psychiatric disorders [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The importance of physical activity increased when the links of aerobic physical activity with the brain cortex and various brain structures such as the hippocampus [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], the amygdala [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], the thalamus were identified and described. What is more, the study of Marques-Aleixo et al. provides a detailed analysis of the positive impact of physical activity on brain cortex and cerebellum mitochondrial functioning. Specific study findings confirmed that physical activity, that is, endurance treadmill training and voluntary free-wheel activity, improved mitochondrial respiratory activity and decreased markers of oxidative stress in both brain subareas [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. These results are in line with the pilot study by Bashir et al. who highlighted enhancing abilities of physical activities on cortical size [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The results of at least two studies conducted in the past decade confirm that physical activity could have a positive impact on cognitive function in ageing, delaying the development and progression of Alzheimer's disease [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Furthermore, several prospective cohort studies show that older people who participated in 150 min per week of moderate physical activity in the previous 5 or more years have a 40% lower risk of developing Alzheimer's disease than sedentary individuals [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAlthough the findings from studies indicate that short-term increases in physical activity and exercise can be beneficial to cognitive and brain health, there is still a lack of evidence of the neuroprotective effects of long-term physical activity in older people. In 2018, a group of American researchers investigated the effects of physical activity on cognitive appraisal and brain structure and came up with desirable results suggesting positive effects [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. However, the research results are retrospective and do not depict a cause-effect relationship between the variables.\u003c/p\u003e\u003cp\u003eAs motor reserve remains a relatively unknown term and most studies on the relationship of physical activity with cognitive assessment have focused on short-term physical activity interventions, the aim of this article is to explore the associations between motor reserve, general cognitive function and brain atrophy in older adults [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eInformation of age, gender, native language, education and living status was obtained using the sociodemographic questionnaire. All participants had at least secondary school education (\u003cem\u003eM\u003c/em\u003e\u003csub\u003e\u003cem\u003eyears\u003c/em\u003e \u003cem\u003eof education\u003c/em\u003e\u003c/sub\u003e = 15.41, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.53) and were living independently at the time of assessment and had no significant memory complaints, no known diagnosis of dementia, cardiovascular, metabolic, pulmonary, respiratory, rheumatological, oncological, psychiatric, or other chronic diseases that could limit physical their participation in the study [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Two recruitment strategies were used. To ensure the variability of the physical activity of the participants, professional veteran and grassroot sports associations were contacted. A public announcement for recruitment was also published in mass media. Before receiving the invitation to the study, each participant received a short clinical interview to assess the compliance with the inclusion criteria.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eGlobal cognitive assessment\u003c/h2\u003e\u003cp\u003eTo control for the general cognition, The Montreal Cognitive Assessment 7.1 (MoCA) was used [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The MoCA test is a screening tool used for general assessment of the symptoms of dementia and mild cognitive impairment and was administered by trained psychologists.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eMotor reserve\u003c/h3\u003e\n\u003cp\u003eThe MR index was calculated based on the total number of years participants engaged in aerobic exercise. Specifically, the reported years of regular physical activity were divided by the number of mature life years, which was defined as 15 years, in line with the relevant cultural context (see Fig.\u0026nbsp;1.). A higher MR index score would reflect a higher motor reserve.\u003c/p\u003e\n\u003ch3\u003eMRI measures\u003c/h3\u003e\n\u003cp\u003eThe images were obtained with the Siemens 1.5 Tesla Avanto magnetic resonance imaging (MRI) machine (Siemens, Erlangen, Germany). High-resolution anatomical images were obtained using a three-dimensional T1 weight magnetization prepared rapid Acquisition Gradient Echo (MPRAGE) sequence [TR\u0026thinsp;=\u0026thinsp;1160 ms, TE\u0026thinsp;=\u0026thinsp;4.44 ms; inversion recovery time (TI)\u0026thinsp;=\u0026thinsp;600 ms; field of view, 230x230 mm\u003csup\u003e2\u003c/sup\u003e; matrix size 256 x 256; flip angle θ\u0026thinsp;=\u0026thinsp;15 degrees; voxel dimensions, 0.9 x 0.9 mm\u003csup\u003e3\u003c/sup\u003e; acquisition time, 5 min].\u003c/p\u003e\n\u003ch3\u003eBrain atrophy calculations\u003c/h3\u003e\n\u003cp\u003eFor grading the participant\u0026rsquo;s level of brain atrophy, 6 visual rating scales - Global Cognitive Atrophy scale (GCA), Medial Temporal Atrophy scale (MTA), Parietal Atrophy scale (PAS), Entorhinal Cortex Atrophy (ERICA) and Frontotemporal Atrophy scale (FTAS) - were used. Rating was performed by a radiology resident and triangulated by a certified radiologist with European Diploma in Radiology (EDiR) certificate and with at least 10 years of experience in neuroradiology.\u003c/p\u003e\u003cp\u003eGlobal Cortical Atrophy scale is the mean score for cortical atrophy throughout the complete cerebrum. The severity of GCA was graded using the four-point scale, where:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e0 points - no cortical atrophy,\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e1 point - mild atrophy with sulcal widening,\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e2 points - moderate atrophy with sulcal widening and mild loss of volume,\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e3 points - sulcal widening and severe loss of volume [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eMedial Temporal Atrophy obtained based on visual rating of coronal T1-weighted MRI images, where width of the choroid fissure, width of the temporal horn, and height of the hippocampal formation are assessed. The severity of MTA on coronal MRI sections were judged on a scale of 0\u0026ndash;4, based on standard images [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The score is determined by visually assessing the choroid fissure width, the temporal horn width, and the hippocampal formation height, where:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eGrade 0 - no atrophy,\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eGrade 1 - only widening of choroid fissure,\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eGrade 2 - also widening of temporal horn of lateral ventricle,\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eGrade 3 - moderate loss of hippocampal volume (decrease in height),\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eGrade 4 - severe volume loss of hippocampus [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eParietal Atrophy scale is based on quantitative scoring of atrophy in three parietal structures through the whole range of parietal lobes (precuneus, sulcus cingularis posterior and parietal gyri) on T1-weighted MRI in sagittal, coronal and axial planes. PAS on both sides were rated on a scale of 0\u0026ndash;3, where:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eGrade 0 \u0026ndash; no cortical atrophy, no widening of the sulci,\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eGrade 1 \u0026ndash; slight atrophy of the parietal lobe, slight enlargement of the sulci in the posterior cingulum and the parieto-occipital lobes,\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eGrade 2 \u0026ndash; marked atrophy of the parietal lobe, widening of sulci in the posterior cingulum and parieto-occipital lobes,\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eGrade 3 \u0026ndash; marked atrophy with a 'knife-blade' atrophy pattern, marked widening of the sulci in the posterior cingulum and parieto-occipital lobes [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eEntorhinal Cortex Atrophy score was obtained on thin slice T1-weighted MRI Coronal images at right angles to the long axis of the hippocampus and assessed at the level of the mammillary bodies. The ERICA scale ranges from 0 (no atrophy) to 3 (severe atrophy) with higher values indicating a higher degree of atrophy based on evaluation of the entorhinal cortex for volume loss:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eGrade 0 \u0026ndash; no atrophy, normal entorhinal cortex,\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eGrade 1 \u0026ndash; slight atrophy and enlargement of the collateral fissure,\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eGrade 2 \u0026ndash; moderate atrophy with separation of the entorhinal cortex from the tentorium cerebelli,\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eGrade 3 \u0026ndash; severe atrophy with atrophy of the parahippocampal cortex, wide gap between the tentorium cerebelli and the entorhinal cortex [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eFrontotemporal Atrophy scale was obtained on thin slice T1-weighted MRI Coronal images at the slice through the temporal pole just anterior to where the \u0026lsquo;temporal stem\u0026rsquo; connects frontal and temporal lobes and the slice showing the lateral geniculate nuclei. The severity of the FTAS was judged on a scale of 0\u0026ndash;5 from \u0026ldquo;normal cortical atrophy\u0026rdquo; to \u0026ldquo;severe cortical atrophy\u0026rdquo; [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eProcedure\u003c/h3\u003e\n\u003cp\u003eData were collected separately for each participant. Prior to admission in the study all participants were interviewed and their medical history was assessed. Participants who met the inclusion criteria were invited to take part in the study. All data were obtained with each participant individually.\u003c/p\u003e\u003cp\u003eStatistical analysis was performed using IBM SPSS Statistics 29. In the first step, data screening was performed, during which no data adjustments were applied and no missing data points were present. To determine the relationship between the motor reserve, general cognitive abilities and brain atrophy, Spearman\u0026rsquo;s Rank-Order Correlation and Hierarchical Regression Analysis controlling for age was used.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e\u003cp\u003ewas obtained from all subjects and/or their legal guardian(s). All methods used in study were carried out in accordance with Rīga Stradiņš University and Latvian Academy of Sport Education scientific guidelines and regulations. Ethical approvals (No. 1/19-05-30 and No. 01-29.1.2/1480) were obtained from the Central Medical Ethics Committee. The study was funded by a research and development grant (No. RSU-PAG-2024/1\u0026ndash;0014) under Riga Stradins University's internal grant scheme and external consolidation with the Latvian Academy of Sport Education.\u003c/p\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eDescriptive statistics\u003c/h2\u003e\u003cp\u003e54 older adults with no self-reported significant neurological, ongoing oncological etc. disorders that might limit their participation in the research, aged from 65 to 85 (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;71.44 years, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;5.01 years) were included in the study.\u003c/p\u003e\u003cp\u003eFor all of the scales, the 25th percentile included only study participants without specific brain part atrophy. Moreover, for all of the scales, except Medial Temporal atrophy scale, the 75th percentile included adults with at least 1st degree specific brain part atrophy. For Global Cortical atrophy scale, left hemisphere Entorhinal Cortex Atrophy scale and left hemisphere Frontotemporal Atrophy scale mode values described 1st degree specific brain part atrophy.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eCorrelation analysis\u003c/h3\u003e\n\u003cp\u003eSpearman\u0026rsquo;s rank-order correlation with Bootstrapping revealed a negative significant correlation between the motor reserve score and Entorhinal Cortex Atrophy scale score in the left hemisphere (\u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.451, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;.001), as well with the whole brain Entorhinal Cortex Atrophy scale score (\u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.417, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.002), and with the Parietal Atrophy scale score in the left hemisphere (\u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.355, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.008) (see full correlation matrix in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eThe Spearman\u0026rsquo;s Rank-Order Correlation between Motor Reserve and the Atrophy measurement scales (Entorhinal Cortex Atrophy scale, Parietal Atrophy scale, Medial Temporal scale and Frontotemporal Atrophy scale).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eVariable\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eCI\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft hemisphere ERICA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.451\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.664; \u0026minus;\u0026thinsp;.186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.121\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight hemisphere ERICA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.324\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.563; \u0026minus;\u0026thinsp;.067\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.017\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhole brain ERICA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.417\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.634; \u0026minus;\u0026thinsp;.146\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft hemisphere PAS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.355\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.584; \u0026minus;\u0026thinsp;.090\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.008\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight hemisphere PAS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.301\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.544; \u0026minus;\u0026thinsp;.032\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.127\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.027\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhole brain PAS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.332\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.565; \u0026minus;\u0026thinsp;.073\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.014\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft Hemisphere MTA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.095\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.362; .185\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.126\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.495\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight hemisphere MTA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.256; .294\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.883\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhole brain MTA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.064\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.333; .215\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.128\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.646\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft hemisphere FTA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.325\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.553; \u0026minus;\u0026thinsp;.058\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.017\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight hemisphere FTA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.198\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.460; .094\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.134\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.150\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhole brain FTA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.276\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.504; .009\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.129\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.044\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eMotor Reserve and Atrophy scale Confidence Intervals of Spearman's rho. The Spearman\u0026rsquo;s Rank-Order Correlation between Motor Reserve and Atrophy scales used in the research.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"15\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eVariable\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eSE (1.)\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e1.\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e2.\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e3.\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003e4.\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003e5.\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003e6.\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003e7.\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cem\u003e8.\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cem\u003e9.\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cem\u003e10.\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cem\u003e11.\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c14\"\u003e\u003cp\u003e\u003cem\u003e12\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c15\"\u003e\u003cp\u003e\u003cem\u003e13.\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1. Motor Reserve\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"14\" nameend=\"c15\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2. Left ERICA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.121\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.451**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"9\" morerows=\"2\" nameend=\"c15\" namest=\"c7\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3. Right ERICA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.324*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4. Whole ERICA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.417**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5. Left PAS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.355**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.244\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.363**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.323*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"6\" morerows=\"2\" nameend=\"c15\" namest=\"c10\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6. Right PAS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.127\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.301*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.179\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.305*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.263\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7. Whole PAS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.332*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.208\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.345*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.296*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8. Left MTA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.126\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.095\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.539**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.585**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.592**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.141\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.069\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.115\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" morerows=\"2\" nameend=\"c15\" namest=\"c13\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9. Right MTA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.205\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.258\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.236\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.035\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.007\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10. Whole MTA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.128\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.064\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.432**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.457**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.466**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.070\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.027\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.056\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11. Left FTA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.325*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.780**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.751**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.818**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.253\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.171\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.219\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.616**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e.361**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e.576**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12. Right FTA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.134\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.198\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.655*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.761**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.750**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.303*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.245\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.280*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.648**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e.302*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e.561**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13. Whole FTA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.129\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.276*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e758**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.793**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.826**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.290*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.214\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.259\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.674**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e.370**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e.610**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003cp\u003e* p\u0026thinsp;\u0026lt;\u0026thinsp;.05; ** p\u0026thinsp;\u0026lt;\u0026thinsp;.01. SE - Standard Error\u003c/h2\u003e\u003cdiv id=\"Sec12\" class=\"Section3\"\u003e\u003ch2\u003eRegression analysis\u003c/h2\u003e\u003cp\u003eHierarchical regression analysis, controlling for age and global cognitive abilities (MoCA) showed that motor reserve explained 10.9% of the variation in the left hemisphere ERICA score (\u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.281, \u003cem\u003eRΔ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.109, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), but for the whole brain ERICA score motor reserve explained 8.4% of the variation (\u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.296, \u003cem\u003eRΔ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.084, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.018) (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eWhat is more, from Parietal Atrophy scale scores only for the left hemisphere it showed that motor reserve proved a significant 7.1% change of the variation (\u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.169, \u003cem\u003eRΔ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.071, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.050). Right hemisphere\u0026rsquo;s score showed that there is not any relation to motor reserve (\u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.214, \u003cem\u003eRΔ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.036, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.138) and there was a lower whole brain score (\u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.200, \u003cem\u003eRΔ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.055, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.069) compared to the left hemisphere.\u003c/p\u003e\u003cp\u003eThere were not any statistically significant associations between Frontotemporal Atrophy scale scores (left hemisphere and whole brain) and motor reserve variations (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.104 and \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.170 respectively) (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eRelationship between age, cognitive abilities (MoCA) and motor reserve with specific brain part atrophy.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eDependent variable\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eR\u0026sup2;\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eΔR\u0026sup2;\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eB\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eSE B\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight hemisphere PA scale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.214\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.036\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.458\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.304\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.193\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e4.526\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.138\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLeft hemisphere PA scale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e.169\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e.071\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.644\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e.312\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.272\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e3.384\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e.044\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhole brain PA scale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.055\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.551\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.296\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.240\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e4.160\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.069\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft hemisphere FTA scale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.311\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.038\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.498\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.301\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.198\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e7.538\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.104\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhole brain FTA scale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.269\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.028\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.389\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.279\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.172\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e6.140\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.170\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLeft hemisphere ERICA score\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e.281\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e.109\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.816\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e.297\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.336\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e6.527\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWhole brain ERICA score\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e.296\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e.084\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.637\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e.261\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.295\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e6.996\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e.018\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003cp\u003e*PA - Parietal Atrophy scale scores (Linear regression analysis)\u003c/h2\u003e\u003cdiv id=\"Sec14\" class=\"Section3\"\u003e\u003cp\u003e*FTA - Frontotemporal Atrophy scale scores (Linear regression analysis)\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analysed during the current study are available in the Rīga Stradiņš University Institutional Repository Dataverse, V1, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.48510/FK2/JCFJZL\u003c/span\u003e\u003cspan address=\"10.48510/FK2/JCFJZL\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to investigate the relationship between motor reserve and brain atrophy in older adults. Our study highlights the significance of motor reserve (long-term physical activity) as a potential factor in delaying cognitive decline, especially in medial temporal and parietal regions. In the last three decades, there has been discussion about the effect of physical exercise on brain and cognitive health. Regular exercise has been associated with a delay in the onset of Alzheimer\u0026rsquo;s disease (AD) [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Moreover, some studies have found evidence that moderate intensity physical activity has a positive effect on the brain's cortex structure [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Several articles support the relationship between higher physical activity and slower structural brain shrinkage [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn cognitively healthy older adults without memory complaints or chronic diseases, greater entorhinal cortex atrophy measured via visual rating scales has been significantly associated with reduced motor reserve, indicating that even subtle degeneration in this early-affected memory region can impair motor resilience [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Similarly, elevated Parietal Atrophy Scale (PAS) scores, reflecting structural decline in parietal regions responsible for visuomotor integration, also correlate with diminished motor performance in elderly cohorts [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Longitudinal evidence further shows that entorhinal atrophy rates significantly predict future cognitive decline, underscoring vulnerability even in individuals with prevailing intact cognition [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Another prospective study demonstrated that overall brain atrophy\u0026mdash;as measured by CT\u0026mdash;predicted poorer performance on complex motor tasks, supporting a broader connection between cortical loss and motor decline even before dementia onset [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Likewise, greater parietal cortex atrophy has been correlated with decreased manual dexterity and gait speed in aging populations, highlighting how structural decline in this region may undermine motor reserve and physical capacity [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. These findings collectively underscore that, among older adults without clinical impairment, visual rating scales such as ERICA and PAS can reveal subtle neuroanatomical changes that meaningfully relate to reductions in motor reserve and may serve as early markers for cognitive\u0026ndash;motor vulnerability.\u003c/p\u003e\u003cp\u003eA research from Simon Fraser University emphasised the difficulty of distinguishing frontotemporal dementia from Alzheimer\u0026rsquo;s disease. Despite a vast list of methods and screening tools, MRI visual assessment remains the primary method of scan interpretation [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Frontotemporal dementia is believed to be the second most common kind of degenerative dementia, however, the early presentation of the frontal type typically comprises non cognitive behavioural domains and personality alterations, which might dominate the clinical picture for a long time before actual cognitive decline manifests [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Similar to the aforementioned study, Tward et al. suggested that measuring entorhinal atrophy at the population level might help determine the efficiency of disease-modifying interventions before cognitive impairments arise [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. However, it is important to note that numerous cognitive subtests were not significantly related to brain atrophy scales, making it uncertain which region of the brain may be affected by exact cognitive decline. Ageing often brings changes in cognitive tasks, requiring more time and mental abilities to complete. Memory and executive functioning, in particular, deteriorate throughout the preclinical case and are the cognitive domains most associated with Alzheimer\u0026rsquo;s progression [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFuture longitudinal studies are needed to assess changes in brain atrophy and global cognitive functioning by MR level to better elucidate causality and directionality of observed associations. Although our sample size was sufficient to test our primary aims, we may have been underpowered when examining the three-way interactions; more data could show some differences in correlation between variables. Secondly, since our sample consisted only of healthy Latvian participants, with female gender representing the greater part of the study, our findings cannot be generalised to a socioeconomically diverse population. What is more, Visual rating scales (VRS) used to assess MRI-detected brain atrophy are limited by observer bias and inter-rater variability, which can significantly impact consistency and diagnostic accuracy. A study by Schmuck et al. reported poor agreement between visual ratings and volumetric software, and concluded that VRS tends to underestimate atrophy [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Furthermore, these scales have limited sensitivity for detecting subtle or early atrophic changes due to their coarse ordinal structure [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Another study emphasized that VRS are age-dependent and less effective in older adults, with reduced discrimination between normal aging and pathological atrophy in participants over 75 years old [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. A key limitation of the study is the reliance on self-reported health status, which is vulnerable to response bias, as participants may overestimate or underestimate their actual health due to social desirability or recall inaccuracies [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWhile the authors recognize that the results of the inferential tests could emerge as significant by chance (i.e., Type I error or \u0026ldquo;false positive\u0026rdquo;), we opted to not to apply Bonferroni correction, as in smaller samples it may increase a risk of Type II error, namely, \u0026ldquo;false negative\u0026rdquo; e.g. [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. The authors acknowledge that the sample size poses some limitations; nonetheless, it is important to highlight that the overall findings align well with those of other independent studies.\u003c/p\u003e\u003cp\u003eThese limitations should be considered against the novelty of the study, including an at-risk group, objectively recorded physical activity, and an investigation of brain atrophy and global cognitive functioning over a key period of ageing.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eOur study provides evidence that greater MR could be associated with a lower rate of parietal and entorhinal atrophy and, consequently, a lower chance of developing cognitive decline symptoms or dementia. In particular, these rates were most pronounced in adults who were assessed for the level of MR as low. Besides, our findings support previous research indicating the significance of the association between cognitive functions and brain structural changes in older adults. There is still no single distinctive exercise approach that can be suggested to preserve cognitive function at all stages of life. Further studies are needed to understand the best level of activity required for brain health, as well as to determine whether there is an optimal time of life to intervene to improve physical activity in people who are not already physically active.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eERICA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEntorhinal Cortex Atrophy Scale\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eFTA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eFrontotemporal Atrophy Scale\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eGCA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eGlobal Cognitive Atrophy Scale\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMoCA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMontreal Cognitive Assessment\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMPRAGE\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMagnetization Prepared Rapid Acquisition Gradient Echo\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMRI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMagnetic Resonance Imaging\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMotor Reserve\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMTA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMedial Temporal Atrophy Scale\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePAS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eParietal Atrophy Scale\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePPA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePrimary Progressive Aphasia\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eTE\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEcho Time\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eTI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInversion Recovery Time\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eTR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eRepetition Time\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eVRS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eVisual Rating Scale\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eWorld Health Organization\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eK.Š., N.Z., K.K., A.S., R.N. did the conceptualization of the research. K.K., K.Š., N.Z. wrote the main manuscript text; Review and editing of the manuscript by K.K., K.Š., N.Z., A.S., R.N.; Methodology was chosen by K.Š., N.Z., K.K., A.S.; Figures, visualisation and data analysis created by K.K., K.Š.; Software was implemented and used by K.K.; Validation of the gathered data was performed by K.Š., N.Z.; Formal analysis by N.Z., K.Š., A.S.; Investigation of the research by N.Z., K.Š., A.S.; Resources by A.S., N.Z., K.Š., A.P.; Data curation by R.N., K.Š., N.Z.; Research supervision by K.Š., N.Z., A.S., A.P.; Project administration A.S., N.Z.; Funding acquisition by A.S., N.Z. All authors reviewed the manuscript.This study was carried out within the State Research Project Modifiable Bio and Life-Style Markers in Predicting Cognitive Decline, MOBILE-COG) (Nr. RSU-PAG-2024/1-0014), and State Research Programme BIOMEDICINE, sub-project No. 5.8.2. \u0026ldquo;Establishing the Net Attainable Benefits of Long-term Exercise\u0026rdquo;.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analysed during the current study are available in the Rīga Stradiņš University Institutional Repository\u0026nbsp;Dataverse,\u0026nbsp;V1, https://doi.org/10.48510/FK2/JCFJZL.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eJennekens, F. G. I. A Short History of the Notion of Neurodegenerative Disease. \u003cem\u003eJ. Hist. 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Opt.\u003c/em\u003e \u003cb\u003e34\u003c/b\u003e, 502\u0026ndash;508. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/opo.12131\u003c/span\u003e\u003cspan address=\"10.1111/opo.12131\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2014).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"brain atrophy, motor reserve, global cognitive functioning, older adults","lastPublishedDoi":"10.21203/rs.3.rs-7507706/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7507706/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAs the population continues to age, a rise in the number of individuals experiencing mild cognitive impairment or dementia symptoms is anticipated. Brain atrophy is strongly associated with cognitive decline that could progress further to dementia. Motor reserve, a cumulative experience of physical activity throughout life, has been identified as a potential protective factor against cognitive decline. This study aimed to investigate the relationship between motor reserve, general cognitive function and brain atrophy in older adults with previously no reported cognitive impairment. All participants underwent detailed assessment of their lifestyle and psychological status, as well as structural magnetic resonance imaging for volumetric brain data. Visual rating scales (Global Cognitive Atrophy scale, Medial Temporal Atrophy scale, Parietal Atrophy scale, Entorhinal Cortex Atrophy, and Frontotemporal Atrophy scale) were used to grade the level of brain atrophy. Montreal Cognitive Assessment screening task was performed to evaluate global cognitive functioning in all subjects. 54 older adults (18.5% men) aged from 65 to 85 (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;71.44 years, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;5.01 years) were included in the study. The study results showed a tendency towards the relationship between several cortical atrophy scales and the motor reserve; nevertheless, after controlling for global cognition, motor reserve was associated only with ERICA score in the left hemisphere and whole brain, and parietal atrophy score in the left hemisphere. The results suggest that individuals with higher motor reserve scores may be less likely to experience brain atrophy in the entorhinal, medial-temporal and parietal cortices; however, due to the small sample, the results should be interpreted with caution.\u003c/p\u003e","manuscriptTitle":"Relationship Between Motor Reserve, General Cognitive Functioning and Brain Atrophy In Older Adults","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-26 06:24:12","doi":"10.21203/rs.3.rs-7507706/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-10T15:11:15+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-09T23:28:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-09T13:46:44+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-30T12:57:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-28T12:07:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"86289927832487337652447146533285019613","date":"2025-09-18T10:53:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"251720831037345710347228397133159567860","date":"2025-09-18T06:00:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"11231584516553655362555826761415726973","date":"2025-09-16T01:31:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"222973211803706438383585845405529078495","date":"2025-09-16T00:26:24+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-16T00:12:23+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-16T00:01:34+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-15T10:33:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-11T20:21:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-09-11T20:19:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"268db659-7479-4134-8c51-77a528e1c77c","owner":[],"postedDate":"September 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":55081894,"name":"Health sciences/Diseases"},{"id":55081895,"name":"Health sciences/Neurology"},{"id":55081896,"name":"Biological sciences/Neuroscience"}],"tags":[],"updatedAt":"2026-05-05T18:08:13+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-26 06:24:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7507706","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7507706","identity":"rs-7507706","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}