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The cognitive reserve theory in the setting of pediatric-onset multiple sclerosis
Luisa Pastò1, Emilio Portaccio2, Benedetta Goretti1
1Department of NEUROFARBA, University of Florence, Florence, Italy.
Insights
Cognitive reserve may protect children with pediatric-onset multiple sclerosis from cognitive decline. Higher reserve is linked to stable or improved cognitive function, aiding in rehabilitation strategies.
Area of Science:
- Neurology
- Neuropsychology
- Pediatrics
Background:
- Pediatric-onset multiple sclerosis (POMS) presents unique challenges for cognitive health.
- Understanding cognitive reserve (CR) is crucial for predicting cognitive impairment (CI) in POMS.
- Identifying at-risk individuals can guide therapeutic interventions.
Purpose of the Study:
- To evaluate the impact of cognitive reserve on cognitive function in POMS patients.
- To determine if higher CR mitigates cognitive decline in this population.
Main Methods:
- A cohort of 48 POMS patients was followed for approximately 4.7 years.
- Cognitive impairment was defined by failure in 3+ neuropsychological tests.
- Cognitive performance changes were assessed using the Reliable Change Index (RCI); CR was measured by IQ.
Main Results:
- At baseline, 29.2% of POMS patients exhibited CI, compared to 3.5% of healthy controls.
- Cognitive deterioration was observed in 37.6% of POMS patients over the follow-up period.
- Higher baseline CR predicted stable or improving cognitive performance in 34 initially cognitively preserved patients (OR=1.11, p=0.006).
Conclusions:
- Elevated cognitive reserve appears to shield POMS patients from cognitive impairment.
- This protective effect is particularly notable in individuals with preserved cognition at the study's outset.
- Findings support the use of CR in counseling and developing rehabilitation strategies for POMS.
Background:
The study of cognitive reserve (CR) in relationship with cognitive impairment (CI) in pediatric-onset multiple sclerosis (POMS) may provide cues to identifying subjects at higher risk of impairment and scope for therapeutic strategies.
Objectives:
To assess the potential impact of CR on cognition in a cohort of POMS patients.
Methods:
In all, 48 POMS patients were followed up for 4.7 ± 0.4 years. CI was defined as the failure of ⩾3 tests on an extensive neuropsychological battery. Change of neuropsychological performance was assessed through the Reliable Change Index (RCI) method. At baseline, CR was estimated by measuring the intelligence quotient (IQ). The relationships were assessed through multivariable regression analyses.
Results:
At baseline, CI was detected in 14/48 (29.2%) patients. Two out of 57 healthy control (HC; 3.5%) met the same criteria of CI (p < 0.001). A deteriorating cognitive performance using the RCI method was observed in 18/48 patients (37.6%). Among the 34 cases who were cognitively preserved at baseline, a higher reserve predicted stable/improving performance (odds ratio (OR) = 1.11; 95% confidence interval (CI): 1.03-1.20; p = 0.006).
Conclusion:
Our results suggest that higher CR in POMS patients may protect from CI, particularly in subjects with initial cognitive preservation, providing relevant implications for counseling and rehabilitation strategies.
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