Abstract
Cognitive dysfunction affects half of MS patients. Although brain atrophy generally yields the most robust MRI correlations with cognition, significant variance in cognition between individual MS patients remains unexplained. Recently, markers of cognitive reserve such as premorbid intelligence have emerged as important predictors of neuropsychological performance in MS. In the present study, we aimed to extend the cognitive reserve construct by examining the potential contribution of occupational attainment to cognitive decline in MS patients. Brain atrophy, estimated premorbid IQ, and occupational attainment were assessed in 72 MS patients. The Minimal Assessment of Cognitive Functioning in MS was used to evaluate indices of information processing speed, memory, and executive function. Results showed that occupational attainment was a significant predictor of information processing speed, memory, and executive function in hierarchical linear regressions after accounting for brain atrophy and premorbid IQ. These data suggest that MS patients with low occupational attainment fare worse cognitively than those with high occupational attainment after controlling for brain atrophy and premorbid IQ. Occupation, like premorbid IQ, therefore may make an independent contribution to cognitive outcome in MS. Information regarding an individual's occupation is easily acquired and may serve as a useful proxy for cognitive reserve in clinical settings.
Highlights
Forty to sixty percent of multiple sclerosis (MS) patients are affected by cognitive impairment of sufficient severity to impede their quality of life [1]
We aimed to extend the cognitive reserve construct by examining the potential contribution of occupational attainment to cognitive decline in MS
Demographic and disease variables including the Expanded Disability Severity Scale (EDSS, [13]) and Multiple Sclerosis Functional Composite Score [14] were collected on the same day as cognitive reserve variables, neuropsychological testing, and magnetic resonance imaging described below
Summary
Forty to sixty percent of multiple sclerosis (MS) patients are affected by cognitive impairment of sufficient severity to impede their quality of life [1] Despite this considerable morbidity, why some patients develop cognitive dysfunction and others do not remain incompletely understood. Premorbid intelligence [6,7,8,9,10] and cognitive leisure [11] were shown to independently account for variance in cognitive function that was unexplained by MS These data suggest that the dissociation of brain pathology from cognitive function in MS may be resolved by a more complete understanding of the elements that comprise cognitive reserve.
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