Abstract
BackgroundPrevious work suggested greater intellectual enrichment might moderate the negative impact of brain atrophy on cognition. This awaits confirmation in independent cohorts including investigation of the role of T2-lesion load (T2-LL), which is another important determinant of cognition in MS. We here thus aimed to test this cognitive reserve hypothesis by investigating whether educational attainment (EA) moderates the negative effects of both brain atrophy and T2-LL on cognitive function in a large sample of MS patients.Methods137 patients participated in the study. Cognition was assessed by the “Brief Repeatable Battery of Neuropsychological Tests.” T2-LL, normalized brain volume (global volume loss) and third ventricle width (regional volume loss) served as MRI markers.ResultsBoth T2-LL and atrophy predicted worse cognition, with a stronger effect of T2-LL. Higher EA (as assessed by years of education) also predicted better cognition. Interactions showed that the negative effects of T2-LL and regional brain atrophy were moderated by EA.ConclusionsIn a cohort with different stages of MS, higher EA attenuated the negative effects of white matter lesion burden and third ventricle width (suggestive of thalamic atrophy) on cognitive performance. Actively enhancing cognitive reserve might thus be a means to reduce or prevent cognitive problems in MS in parallel to disease modifying drugs.
Highlights
The cognitive reserve hypothesis suggests that greater intellectual enrichment (e.g. educational attainment (EA); occupational attainment, vocabulary knowledge, premorbid cognitive leisure activity) might moderate the negative impact of pathologic brain changes, such as atrophy, on cognition [1,2,3,4,5,6,7]
As T2-lesion load (T2-LL) represents another major predictor of cognitive function in multiple sclerosis (MS), we aimed to test the cognitive reserve hypothesis in a large sample of MS patients from a single center (Graz), using atrophy and T2-LL data
Lesion load is known to be an important predictor of cognitive function in MS [14], most studies investigating the cognitive reserve hypothesis so far only used global or regional brain atrophy to assess disease burden in MS patients
Summary
The cognitive reserve hypothesis suggests that greater intellectual enrichment (e.g. educational attainment (EA); occupational attainment, vocabulary knowledge, premorbid cognitive leisure activity) might moderate the negative impact of pathologic brain changes, such as atrophy, on cognition [1,2,3,4,5,6,7].In multiple sclerosis (MS), the relationship between MRImarkers of disease-related tissue changes and cognitive status is variable. Previous work suggested greater intellectual enrichment might moderate the negative impact of pathologic brain changes on cognition in MS patients [2] This finding needs replication in other independent cohorts and has been mostly restricted to mitigating effects on global and regional atrophy measures so far. Previous work suggested greater intellectual enrichment might moderate the negative impact of brain atrophy on cognition This awaits confirmation in independent cohorts including investigation of the role of T2-lesion load (T2-LL), which is another important determinant of cognition in MS. We here aimed to test this cognitive reserve hypothesis by investigating whether educational attainment (EA) moderates the negative effects of both brain atrophy and T2-LL on cognitive function in a large sample of MS patients
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