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Cognitive reserve and symptom experience in multiple sclerosis: a buffer to disability progression over time?
Carolyn E Schwartz1, Brian R Quaranto, Brian C Healy
1DeltaQuest Foundation, Inc, Concord, MA; Departments of Medicine and Orthopaedic Surgery, Tufts University Medical School, Boston, MA.
Archives of Physical Medicine and Rehabilitation
|June 4, 2013
Summary
Active cognitive reserve buffers functional limitations in multiple sclerosis (MS). Higher active reserve is linked to a less severe disease course and slower disability progression, suggesting a protective effect against MS worsening.
Area of Science:
- Neurology
- Neuroscience
- Rehabilitation Science
Background:
- Multiple sclerosis (MS) is a chronic neurological disease characterized by unpredictable symptom experience and disease course.
- Cognitive reserve, the brain's resilience to neuropathological changes, may influence how individuals experience MS.
- Understanding factors that buffer symptom burden and disease progression is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the buffering effect of cognitive reserve on symptom experience in the context of multiple sclerosis (MS) disease course.
- To determine if active and passive cognitive reserve influence the progression and manifestation of MS symptoms and disability.
Main Methods:
- Secondary analysis of longitudinal data from the North American Research Committee on MS Registry, including 859 participants with MS.
- Measurement of active and passive cognitive reserve using validated tools (Stern Leisure Activities and Sole-Padulles Childhood Enrichment).
- Statistical modeling (linear regression, chi-square, multilevel modeling, classification and regression trees) to analyze relationships between cognitive reserve, symptom burden, and disease course.
Main Results:
- Higher active cognitive reserve was associated with a significantly lesser symptom burden, independent of passive reserve (P<.01).
- Active cognitive reserve influenced the disease course, with high-active individuals more often presenting with relapsing-remitting MS and less often with progressive disease (χ(2)=14.7, P<.03).
- Longitudinal analyses revealed a significant interaction between active reserve and time, impacting mobility, fatigue, and overall disability (P<.05), with active reserve associated with less deterioration (P<.001). Passive reserve showed no significant longitudinal effect.
Conclusions:
- Active cognitive reserve acts as a buffer against functional limitations across different disability levels in MS.
- Cognitive reserve may offer a new perspective on MS disease progression, potentially extending the period before significant disability accrual through mechanisms like cortical remodeling.
- A decline in active cognitive reserve might be a key factor contributing to the onset of progressive forms of MS.
Keywords:
Cognitive reserveCourse of diseaseMRIMSMultiple sclerosisNARCOMSNatural historyNorth American Research Committee on Multiple SclerosisPPMSPeople with disabilitiesRRMSRehabilitationSPMSSecondary progressive multiple sclerosisSymptomsmagnetic resonance imagingmultiple sclerosisprimary progressive multiple sclerosisrelapsing-remitting multiple sclerosissecondary progressive multiple sclerosis
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