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Sub-threshold cognitive impairment in multiple sclerosis: the association with cognitive reserve
Anthony Feinstein1, Helen Lapshin, Paul O'Connor
1Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Toronto, ON M4N 3M5, Canada. ant.feinstein@utoronto.ca
Journal of Neurology
|June 6, 2013
Summary
High intellect in multiple sclerosis (MS) patients may mask cognitive decline. Cognitive reserve softens the impact of neurological deficits, even when not meeting global impairment thresholds.
Area of Science:
- Neuroscience
- Cognitive Psychology
- Neurology
Background:
- Multiple sclerosis (MS) is associated with cognitive decline.
- Cognitive reserve, influenced by premorbid intellect, may protect against cognitive impairment in MS.
- A subgroup of MS patients may exhibit cognitive deficits relative to their premorbid abilities despite appearing intact on standard tests.
Purpose of the Study:
- To explore the neurological and behavioral characteristics of MS patients with high premorbid intellect who show a decline in cognitive function relative to their baseline.
- To identify factors contributing to cognitive reserve in MS.
- To differentiate between cognitively intact, impaired, and those with a decline relative to premorbid estimates in MS.
Main Methods:
- Cross-sectional study of 144 MS patients.
- Neuropsychological testing using the Minimal Assessment of Cognitive Function in MS (MACFIMS) battery.
- Premorbid intelligence estimation using the ANART reading test and a validated algorithm comparing current performance to premorbid estimates.
Main Results:
- Three groups were identified: cognitively intact (n=53), impaired (n=46), and intact but below premorbid estimates (n=45).
- Patients intact but below premorbid estimates had higher premorbid IQ and lower EDSS scores than impaired patients.
- This subgroup outperformed impaired patients on most cognitive tests but showed deficits in auditory processing (PASAT-3) and were more likely to be employed.
Conclusions:
- A subset of MS patients with high premorbid IQ demonstrates cognitive decline relative to their baseline, despite appearing intact on standard assessments.
- Cognitive reserve, indicated by high premorbid IQ, 'softens' the impact of cognitive decline in MS rather than preventing it.
- These findings highlight the importance of considering cognitive reserve in understanding cognitive dysfunction in multiple sclerosis.
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