Archives of Physical Medicine and Rehabilitation
Orginal articleCognitive Reserve and Symptom Experience in Multiple Sclerosis: A Buffer to Disability Progression Over Time?
Section snippets
Sample and design
This project involved secondary analysis of longitudinal data from 859 people who provided data in a supplemental survey to the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry. This self-report registry includes more than 36,000 individuals 18 years or older, reporting clinician-diagnosed MS. Participants are not paid to be part of NARCOMS, but rather volunteer to participate to expedite MS research. The registry supports a host of epidemiologic studies. The
MS health outcomes
Three disease-specific health outcome measures were selected on the basis of their documented reliability and validity, as well as their availability in this existing data set. They included (1) the Symptom Inventory disability-specific short forms, a 10-subscale measure of MS symptoms that focuses on discriminating levels of disability in mobility, use of assistive devices, hand function, vision, fatigue, cognition, bowel/bladder, spasticity, sensory, and vasomotor symptoms10, 11, 12; (2) the
Sample description
Table 1 shows the sample demographic characteristics. Participants in the study sample had a mean age of 54 years, and 74% of the participants were women, which is consistent with the sex distribution in MS.24 Less than half of the sample was employed, with a median annual household income between $50,000 and $100,000 in the whole sample.
A comparison of cognitive-reserve group differences (see table 1) suggests that the groups differed in terms of proportion of women (P<.03), mean age (P<.001),
Discussion
Our findings suggest that active cognitive reserve appears to be associated with a milder disease course based on cross-sectional and some longitudinal analyses. Patients with MS who have high-active cognitive reserve report a significantly lower symptom burden. Further, among those patients whose disability changed over time, the high-active reserve patients showed less deterioration (negative β coefficient) over time than those with low active reserve. Active reserve may thus be a buffer for
Conclusions
In summary, our findings support the idea that active cognitive reserve is a buffer against symptom burden and onset of progressive disease. Because of the above-mentioned study limitations, our study findings cannot confirm causal relationships but rather can generate hypotheses that must be tested and replicated in other MS samples. Future research should test the hypotheses generated by the present work. We believe that active cognitive reserve is something that individuals can be assisted
Suppliers
- a.
Stata Statistical Software, Release 12; StataCorp LP, 4905 Lakeway Dr, College Station, TX 77845.
- b.
The R Foundation for Statistical Computing, Vienna, Austria. Available at: http://www.r-project.org.
Acknowledgments
We thank Gary Cutter, PhD, Stacey Cofield, PhD, and Rita Bode, PhD, for data management services early in the project; and Ruth Ann Marrie, MD, PhD, and Robert Fox, MD, for helpful comments on an earlier draft of this manuscript.
References (35)
Cognitive reserve
Neuropsychologia
(2009)- et al.
Therapy-induced plasticity of cognitive functions in MS patients: insights from fMRI
J Physiol Paris
(2006) - et al.
The neurobiology of brain and cognitive reserve: mental and physical activity as modulators of brain disorders
Prog Neurobiol
(2009) - et al.
Cognitive reserve and appraisal in multiple sclerosis
Mult Scler Relat Disord
(2013) - et al.
Brain structure and function related to cognitive reserve variables in normal aging, mild cognitive impairment and Alzheimer's disease
Neurobiol Aging
(2009) MRI relapses have significant pathologic and clinical implications in multiple sclerosis
J Neurol Sci
(2007)- et al.
Activities of daily living, cerebral glucose metabolism, and cognitive reserve in Lewy body and Parkinson's disease
Dement Geriatr Cogn Disord
(2008) - et al.
Cognitive reserve and patient-reported outcomes
Mult Scler
(2013) - et al.
Altruism and health outcomes in multiple sclerosis: the effect of cognitive reserve
J Posit Psychol
(2013)
Validation of the NARCOMS Registry: diagnosis
Mult Scler
Reliability and validity of two self-report measures of impairment and disability for MS. North American Research Consortium on Multiple Sclerosis Outcomes Study Group
Neurology
The Symptom Inventory disability-specific short-forms for multiple sclerosis: construct validity, responsiveness, and interpretation
Arch Phys Med Rehabil
The Symptom Inventory disability-specific short-forms for multiple sclerosis: reliability and factor structure
Arch Phys Med Rehabil
Disease steps in multiple sclerosis: a simple approach to evaluate disease progression
Neurology
Influence of leisure activity on the incidence of Alzheimer's disease
Neurology
Validation of the NARCOMS Registry: depression assessment
Int J MS Care
Cited by (44)
Systematic review of cognitive reserve in multiple sclerosis: Accounting for physical disability, fatigue, depression, and anxiety
2023, Multiple Sclerosis and Related DisordersLifestyle factors in multiple sclerosis disability progression and silent brain damage: A cross-sectional study
2022, Multiple Sclerosis and Related DisordersCognitive reserve protects language functions in patients with brain tumours
2021, NeuropsychologiaPrognostic factors of disability in relapsing remitting multiple sclerosis
2019, Multiple Sclerosis and Related Disorders
Dr. Schwartz received research support from the National Multiple Sclerosis Society and the Foundation of the Consortium of Multiple Sclerosis Centers. Part of the data collected for this work was provided in the context of a Consortium of Multiple Sclerosis Centers/Global Multiple Sclerosis Registry Visiting Scientist Fellowship to Dr. Schwartz, which was supported through a Foundation of the Consortium of Multiple Sclerosis Centers grant from EMD Serono, Inc. Consortium of Multiple Sclerosis Centers/Global Multiple Sclerosis Registry is supported by the Consortium of Multiple Sclerosis Centers and its Foundation. Dr. Healy receives research support from Merck Serono S.A. Dr. Benedict receives Continuing Medical Education support from Teva and EMD Serono; research support from Shire, Accorda, and Biogen; consultancy or AdvBoard support from Bayer, Biogen, Novartis, Actelion, and MedImmune; and royalties from Psychological Assessment Resources, Inc. In the past 2 years, Dr. Vollmer has received honoraria for serving on scientific advisory boards, or as a consultant from Teva Neuroscience, Biogen Idec, Elan Pharmaceuticals, Hoffman LaRoche, Accelerated Cure Project, MedicalLogix, Xenoport, PRIME Education, Projects in Knowledge, Guidepoint Global, Esai Pharmaceuticals, Sanofi-Aventis, Novartis, Schering-Plough, Buffalo Neurological Institute, Consortium of Multiple Sclerosis Centers, Acorda Pharm, and research support from Acorda Therapeutics, Biogen Idec, Teva Neuroscience, Genzyme, Ono Pharmaceuticals, Eli Lilly, Novartis, Elan Pharmaceuticals, National Institutes of Health, Biosite, Daiichi Sankyo, Rocky Mountain Multiple Sclerosis Center, and Jansen Research & Development.
No commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a benefit on the authors or on any organization with which the authors are associated.