Literature Review

Brain and Cognitive Reserve May Protect Against Cognitive Decline in MS



Patients with multiple sclerosis (MS) and larger maximal lifetime brain growth (MLBG) had less decline in cognitive efficiency, and patients with greater intellectual enrichment had a lower risk for decline in cognitive efficiency and memory over 4.5 years, according to a study published May 20 in Neurology.

James F. Sumowski, PhD, Senior Research Scientist of Neuropsychology and Neuroscience at the Kessler Foundation Research Center in West Orange, New Jersey, and colleagues evaluated cognitive efficiency and memory in 40 patients with MS at baseline and at a 4.5-year follow-up. The researchers used MRI to quantify disease progression and percentage change in T2 lesion volume.

Dr. Sumowski’s group found that the patients declined in cognitive efficiency and memory. MLBG moderated decline in cognitive efficiency, and larger MLBG protected against this decline. However, MLBG did not moderate memory decline. Also, intellectual enrichment moderated decline in cognitive efficiency and memory, and greater intellectual enrichment protected against decline. In addition, MS disease progression was more negatively associated with change in cognitive efficiency and memory among patients with lower versus higher MLBG and intellectual enrichment.

“Clinically, it is difficult to predict which patients with MS are at greatest risk of cognitive decline because it is difficult to accurately predict MS disease progression for any given patient,” stated the researchers. “MLBG and intellectual enrichment are important factors to consider when trying to predict cognitive decline in patients with MS, because patients with lower MLBG and/or lesser intellectual enrichment are at greatest risk of cognitive decline. These at-risk patients can be targeted for early-intervention cognitive rehabilitation, which may help prevent/delay the onset of functional impairment.

“Higher cardiorespiratory fitness may help preserve brain volume and cognitive efficiency, and preliminary data show that aerobic exercise training may result in improved memory, increased hippocampal volume, and increased hippocampal functional connectivity in patients with MS,” the investigators commented. “Finally, patients with MS should also be encouraged to engage in intellectual enrichment (eg, reading, hobbies, etc), because previous research and the current findings suggest that greater intellectual enrichment protects against cognitive decline.”

Colby Stong

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