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Original article| Volume 70, 104482, February 2023

Cognitive reserve as a moderating factor between EDSS and cognition in multiple sclerosis

Published:December 23, 2022DOI:https://doi.org/10.1016/j.msard.2022.104482

      Highlights

      • Cognitive reserve represents the plasticity properties of the brain to resist damage caused by disease and/or aging.
      • The protective role of CR seems to target certain specific cognitive functions.
      • Tasks posing a greater cognitive challenge seem to benefit more from the protective effects of CR.

      Abstract

      Objectives

      It is now well recognized that brain damage and/or atrophy apparent on MRI is only moderately correlated to cognitive functioning. The cognitive reserve (CR) hypothesis has been proposed to explain this functional heterogeneity, but it has only been addressed recently in the MS literature and has not yet been thoroughly investigated. The objective of this study is to examine the protective role of CR in cognition using a standardized CR tool in a population with a wide age range.

      Methods

      A neuropsychological evaluation was performed on 84 pwMS aged between 27 and 78 years old and the CR Index questionnaire (CRIq) was used to estimate CR. The EDSS scale was used to assess the degree of neurologic impairment and estimate the disease burden.

      Results

      A moderating effect of CR was observed in the relationship between EDSS score and specific cognitive domains: processing efficiency, visuospatial learning and memory, as well as a tendency for verbal memory. In pwMS with a high level of CR, there was no negative relationship between these cognitive domains and EDSS.

      Conclusion

      The results support the protective role of CR in a sample of pwMS with a wide age range. This role seems to be limited to specific cognitive tasks that pose a greater challenge and therefore require greater adaptability.

      Keywords

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      References

        • Arnett P.A.
        Does cognitive reserve apply to multiple sclerosis?.
        Neurology. 2010; 74: 1934-1935
        • Artemiadis A.
        • Bakirtzis C.
        • Ifantopoulou P.
        • Zis P.
        • Bargiotas P.
        • Grigoriadis N.
        • Hadjigeorgiou G.
        The role of cognitive reserve in multiple sclerosis: a cross-sectional study in 526 patients.
        Mult. Scler. Relat. Disord. 2020; 41102047
        • Benedict
        • Cookfair D.
        • Gavett R.
        • Gunther M.
        • Munschauer F.
        • Garg N.
        • Weinstock-Guttman B.
        Validity of the minimal assessment of cognitive function in multiple sclerosis (MACFIMS).
        J. Int. Neuropsychol. Soc. 2006; 12: 549-558
        • Bonnet M.C.
        • Deloire M.S.
        • Salort E.
        • Dousset V.
        • Petry K.G.
        • Brochet B.
        • Group A.S.
        Evidence of cognitive compensation associated with educational level in early relapsing–remitting multiple sclerosis.
        J. Neurol. Sci. 2006; 251: 23-28
        • Brassat D.
        Physiopathologie de la sclérose en plaques.
        Presse Méd. 2010; 39: 341-348
        • Buhse M.
        The elderly person with multiple sclerosis: clinical implications for the increasing life-span.
        J. Neurosci. Nurs. 2015; 47: 333-339
        • Chiaravalloti N.D.
        • DeLuca J.
        Cognitive impairment in multiple sclerosis.
        Lancet Neurol. 2008; 7: 1139-1151
        • Deloire M.
        • Ruet A.
        • Hamel D.
        • Bonnet M.
        • Brochet B.
        Early cognitive impairment in multiple sclerosis predicts disability outcome several years later.
        Mult. Scler. J. 2010; 16: 581-587
        • Dusankova J.B.
        • Kalincik T.
        • Havrdova E.
        • Benedict R.H.
        Cross cultural validation of the minimal assessment of cognitive function in multiple sclerosis (MACFIMS) and the brief international cognitive assessment for multiple sclerosis (BICAMS).
        Clin. Neuropsychol. 2012; 26: 1186-1200https://doi.org/10.1080/13854046.2012.725101
        • Fenu G.
        • Lorefice L.
        • Arru M.
        • Sechi V.
        • Loi L.
        • Contu F.
        • Fronza M.
        Cognition in multiple sclerosis: Between cognitive reserve and brain volume.
        J. Neurol. Sci. 2018; 386: 19-22
        • Fischer M.
        • Kunkel A.
        • Bublak P.
        • Faiss J.H.
        • Hoffmann F.
        • Sailer M.
        • Köhler W.
        How reliable is the classification of cognitive impairment across different criteria in early and late stages of multiple sclerosis?.
        J. Neurol. Sci. 2014; 343: 91-99
        • Hohman T.
        • McLaren D.
        • Mormino E.
        • Gifford K.
        • Libon D.
        • Jefferson A.
        • Initiative Alzheimer's Disease Neuroimaging
        Asymptomatic alzheimer disease: defining resilience.
        Neurology. 2016; 87: 2443-2450
        • Jobin C.
        • Larochelle C.
        • Parpal H.
        • Coyle P.K.
        • Duquette P.
        Gender issues in multiple sclerosis: an update.
        Women's Health. 2010; 6: 797-820
        • Katzman R.
        • Aronson M.
        • Fuld P.
        • Kawas C.
        • Brown T.
        • Morgenstern H.
        • Ooi W.L.
        Development of dementing illnesses in an 80-year-old volunteer cohort.
        Ann. Neurol. 1989; 25 (Official Journal of the American Neurological Association and the Child Neurology Society): 317-324
        • Korakas N.
        • Tsolaki M.
        Cognitive impairment in multiple sclerosis: a review of neuropsychological assessments.
        Cogn. Behav. Neurol. 2016; 29: 55-67
        • Kurtzke J.F.
        Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS).
        Neurology. 1983; 33 (1444): 1444
        • Leon I.
        • Garcia-Garcia J.
        • Roldan-Tapia L.
        Estimating cognitive reserve in healthy adults using the cognitive reserve scale.
        PLoS One. 2014; 9e102632https://doi.org/10.1371/journal.pone.0102632
        • Da Silva M.
        • Moreira C.
        • Santos B.
        • Dias P.
        Cognitive reserve in multiple sclerosis: protective effects of education.
        Mult. Scler. J. 2015; 21: 1312-1321
        • Nucci M.
        • Mapelli D.
        • Mondini S.
        Cognitive reserve index questionnaire (CRIq): a new instrument for measuring cognitive reserve.
        Aging Clin. Exp. Res. 2012; 24: 218-226
        • Nunnari D.
        • De Cola M.C.
        • Costa A.
        • Rifici C.
        • Bramanti P.
        • Marino S.
        Exploring cognitive reserve in multiple sclerosis: new findings from a cross-sectional study.
        J. Clin. Exp. Neuropsychol. 2016; 38: 1158-1167
        • Opdebeeck C.
        • Martyr A.
        • Clare L.
        Cognitive reserve and cognitive function in healthy older people: a meta-analysis.
        Aging Neuropsychol. Cogn. 2016; 23: 40-60
        • Polliack M.L.
        • Barak Y.
        • Achiron A.
        Late-onset multiple sclerosis.
        J. Am. Geriatr. Soc. 2001; 49: 168-171
        • Polman C.H.
        • Reingold S.C.
        • Edan G.
        • Filippi M.
        • Hartung H.P.
        • Kappos L.
        • O'Connor P.W.
        Diagnostic criteria for multiple sclerosis: 2005 revisions to the “McDonald Criteria.
        Ann. Neurol. 2005; 58: 840-846
        • Sanai S.A.
        • Saini V.
        • Benedict R.H.
        • Zivadinov R.
        • Teter B.E.
        • Ramanathan M.
        • Weinstock-Guttman B.
        Aging and multiple sclerosis.
        Mult. Scler. J. 2016; 22: 717-725
        • Santangelo G.
        • Altieri M.
        • Enzinger C.
        • Gallo A.
        • Trojano L.
        Cognitive reserve and neuropsychological performance in multiple sclerosis: a meta-analysis.
        Neuropsychology. 2019; 33: 379
        • Santangelo G.
        • Altieri M.
        • Gallo A.
        • Trojano L.
        Does cognitive reserve play any role in multiple sclerosis? A meta-analytic study.
        Mult. Scler. Relat. Disord. 2019; 30: 265-276
        • Satz P.
        Brain reserve capacity on symptom onset after brain injury: a formulation and review of evidence for threshold theory.
        Neuropsychology. 1993; 7: 273
        • Steffener J.
        • Stern Y.
        Exploring the neural basis of cognitive reserve in aging.
        Biochim. Biophys. Acta BBA Mol. Basis Dis. 2012; 1822: 467-473
        • Stern
        Cognitive reserve.
        Neuropsychologia. 2009; 47: 2015-2028
        • Stern
        • Alexander G.E.
        • Prohovnik I.
        • Mayeux R.
        Inverse relationship between education and parietotemporal perfusion deficit in Alzheimer's disease.
        Ann. Neurol. 1992; 32 (Official Journal of the American Neurological Association and the Child Neurology Society): 371-375
        • Sumowski J.F.
        • Chiaravalloti N.
        • DeLuca J.
        Cognitive reserve protects against cognitive dysfunction in multiple sclerosis.
        J. Clin. Exp. Neuropsychol. 2009; 31: 913-926
        • Sumowski J.F.
        • Leavitt V.M.
        Cognitive reserve in multiple sclerosis.
        Mult. Scler. J. 2013; 19: 1122-1127
        • Sumowski J.
        • Wylie G.
        • Gonnella A.
        • Chiaravalloti N.
        • Deluca J.
        Premorbid cognitive leisure independently contributes to cognitive reserve in multiple sclerosis.
        Neurology. 2010; 75: 1428-1431
        • Sumowski J.F.
        Cognitive reserve as a useful concept for early intervention research in multiple sclerosis.
        Front. Neurol. 2015; 6: 176https://doi.org/10.3389/fneur.2015.00176
        • Sumowski J.F.
        • Chiaravalloti N.
        • Leavitt V.M.
        • Deluca J.
        Cognitive reserve in secondary progressive multiple sclerosis.
        Mult. Scler. 2012; 18: 1454-1458https://doi.org/10.1177/1352458512440205
        • Tucker
        • Stern
        Cognitive reserve in aging.
        Curr. Alzheimer Res. 2011; 8: 354-360