Original article| Volume 70, 104482, February 2023

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

Published:December 23, 2022DOI:


      • 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.



      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.


      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.


      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.


      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.


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