Highlights
- •Disability and depression were strongly associated with cognition in MS.
- •Cognitive reserve moderated the effect of grey matter on verbal memory.
- •Brain reserve moderated the effect of brain volume on verbal memory.
Abstract
Background
Cognitive impairment (CI) is detected in 40–70% of multiple sclerosis (MS) patients,
but only 33–50% of the CI variance is explained by the disease burden assessed by
MRI. The cognitive reserve (CR) hypothesis has been postulated to account for this
discrepancy. So far, most previous studies have confirmed the CR hypothesis in MS
but failed to examine CR indices collectively or use clinically relevant neuropsychological
assessments. The aim of this study was to replicate previous findings for the effect
of CR (and its counterpart; brain reserve-BR) in MS by considering these caveats.
Methods
128 RRMS and 13 SPMS patients were recruited in this cross-sectional study (mean age
43.5 ± 10.4 years old, 73% females, mean disease duration 153.7 ± 89.4). CR was assessed
by the Cognitive Reserve Index questionnaire (CRIq) and BR by the intracranial volume.
Neuropsychological assessment was made by using the recommended for clinicians Brief
International Cognitive Assessment for MS (BICAMS) tool. Other measurements included
clinical characteristics, psychological status, fatigue, and MRI volumetric imaging
parameters. Multiple linear regression models were implemented to ascertain the putative
moderating role (i.e. interaction terms) of CR and BR in cognition.
Results
Exploratory univariate analyses revealed significant negative correlations between
both disability and depression with cognitive scores (rho = −0.382, p < 0.001, rho = −0.278, p = 0.001, respectively), only. After controlling for gender, disability and depression,
a significant moderating protective effect of CR on the associations between both
grey and peripheral grey matter volumes with verbal memory was found (beta = 1.834,
p = 0.045, beta = 1.936, p = 0.04 for the interaction terms, respectively). Also, BR moderated the effect of
the total brain volume on verbal memory (beta = 1.516, p = 0.043).
Conclusion
This study showed that by using composite measures of CR and simple, clinically-orientated
neuropsychological assessments, the protective role of CR and BR is mostly restricted
to memory function. Future research should embark on investigating interventions that
will aim to enhance CR for the prevention of CI in MS.
Keywords
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Article info
Publication history
Published online: July 29, 2019
Accepted:
July 27,
2019
Received in revised form:
June 29,
2019
Received:
February 7,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
