Measurement and maintenance of reserve in multiple sclerosis

Cognitive dysfunction is highly prevalent, disabling, and poorly managed in persons with multiple sclerosis (MS). However, not all persons with MS present with cognitive impairment despite having grey and white matter pathology. To explain such an observation, much attention has been drawn to other factors, namely the concept of reserve (i.e., protection against clinical manifestations of neurological damage). There is a growing body of evidence supporting brain reserve and cognitive reserve for mitigating the deleterious effects of MS pathology on cognition in MS. Measurement and maintenance of reserve is paramount. The current review addresses measures of brain and cognitive reserve, separately, that have been adopted in MS research. These measures are largely based on genetics and premorbid behavior. We propose that reserve may not be limited to premorbid factors that are not highly amenable to change. Rather, reserve can be built and maintained over time based on ongoing participation in cognitively stimulating activities. We conclude with recommendations for future research on reserve in MS samples. This will provide keen insight into potential applications for building reserve and ultimately improving the well-being of those with MS across multiple domains.