Background Cognitive reserve (CR) is one factor that helps to maintain cognitive function in patients with Alzheimer’s disease (AD). Whether the effects of CR depend on the semantic/executive components of the task remains unknown.

Methods 470 patients (138 with AD, 332 with mild cognitive impairment (MCI)) were selected from the Alzheimer’s Disease Neuroimaging Initiative database. Linear regression models were used to determine the effects of CR (years of education) on cognitive performance after controlling for demographic factors and regional cortical atrophy. First, we assessed memory tasks with low (Auditory Verbal Learning Test (AVLT) discriminability), moderate (AVLT delayed recall) and high (Logical Memory Test (LMT) delayed recall) executive/semantic components. Next, we assessed tasks with lower (digit span forward, Trails A) or higher (digit span backwards, Trails B) executive demands, and lower (figure copying) or higher (naming, semantic fluency) semantic demands.

Results High CR was significantly associated with performance on the LMT delayed recall, approached significance in the AVLT delayed recall and was not significantly associated with performance on AVLT discriminability. High CR was significantly associated with performance on the Trails B and digit span backwards, mildly associated with Trails A performance and was not associated with performance on digit span forwards. High CR was associated with performance on semantic but not visuospatial tasks. High CR was associated with semantic tasks in patients with both MCI and AD, but was only associated with executive functions in patients with MCI.

Conclusion CR may relate to executive functioning and semantic knowledge, leading to preserved cognitive performance in patients with AD pathology.