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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
PubMed
Abstract

Insights

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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