Implementation of a Program to Enhance Cognitive Reserve in Patients With Multiple Sclerosis (EM Reserva Program)

Area of Science:

• Neuroscience
• Rehabilitation Medicine
• Clinical Psychology

Background:

• Cognitive reserve (CR) may protect against cognitive decline in people with multiple sclerosis (PwMS).
• Few interventions target CR enhancement, especially in individuals without baseline cognitive impairment.
• The EM Reserva program is a multimodal intervention (cognitive activities, aerobic exercise, social engagement) to strengthen CR in relapsing-remitting MS (RRMS).

Purpose of the Study:

• To evaluate the effectiveness of the EM Reserva program in enhancing cognitive reserve in PwMS without cognitive impairment.
• To assess the impact of the intervention on cognitive function, fatigue, and quality of life.

Main Methods:

• A pragmatic, single-center, observer-blinded randomized controlled trial.
• Included PwMS (18-55 years) with RRMS and no cognitive impairment, randomized 1:1 to EM Reserva or usual care.
• Primary endpoint: change in Symbol Digit Modalities Test (SDMT) at 6 months; secondary outcomes included other neuropsychological tests, fatigue, and quality of life measures.

Main Results:

• At 6 months, the EM Reserva group showed significant improvements in SDMT and verbal fluency (COWAT) compared to controls.
• Cognitive gains were not sustained at 12 months.
• Fatigue improved in both groups at 6 months, but remained significantly lower only in the EM Reserva group at 12 months. No differences in perceived deficits or quality of life.

Conclusions:

• The EM Reserva program offers short-term cognitive benefits (processing speed, verbal fluency) and sustained fatigue reduction in cognitively preserved PwMS.
• Cognitive benefits were not maintained long-term, and subjective cognitive functioning was unchanged.
• Multimodal CR interventions may provide temporary advantages, highlighting the need for long-term maintenance strategies.