Ana Martins Da Silva1, Sara Cavaco2, Inês Moreira3, Andreia Bettencourt3, Ernestina Santos2, Cláudia Pinto2, Alexandra Gonçalves4, Ester Coutinho5, Raquel Samões5, Cláudia C Dias6, Armando Teixeira-Pinto7, Berta Martins Da Silva3, Xavier Montalban8. 1. Neurology Service, Hospital de Santo António, Porto, Portugal/Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Institute of Biomedical Sciences, University of Porto - UMIB/ICBAS/UP anaadmsilva@gmail.com. 2. Neurology Service, Hospital de Santo António, Porto, Portugal/Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Institute of Biomedical Sciences, University of Porto - UMIB/ICBAS/UP. 3. Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Institute of Biomedical Sciences, University of Porto - UMIB/ICBAS/UP. 4. Neurology Service, Hospital de Santo António, Porto, Portugal/Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Institute of Biomedical Sciences, University of Porto - UMIB/ICBAS/UP/Faculty of Medicine, University of Porto, Portugal. 5. Neurology Service, Hospital de Santo António, Porto, Portugal. 6. Faculty of Medicine, University of Porto, Portugal/CINTESIS - Centre for Research in Health Informatics Systems and Technologies, Porto, Portugal. 7. CINTESIS - Centre for Research in Health Informatics Systems and Technologies, Porto, Portugal/Sydney School of Public Health, University of Sydney, Australia. 8. Unitat de Neuroimmunologia Clínica, Centre d'Esclerosi Multiple de Catalunya, Barcelona, Spain.
Abstract
BACKGROUND: Recent data suggest that cognitive reserve modulates the adverse effects of multiple sclerosis (MS) pathology on cognitive functioning; however, the protective effects of education in MS are still unclear. OBJECTIVE: To explore education as an indicator of cognitive reserve, while controlling for demographic, clinical and genetic features. METHODS: A total of 419 MS patients and 159 healthy comparison (HC) subjects underwent a comprehensive neuropsychological (NP) assessment, and answered the Hospital Anxiety and Depression Scale. Based on the HC data, MS patients' NP scores were adjusted for sex, age and education; and the estimated 5(th) percentile (or 95(th) percentile, when appropriate) was used to identify any deficits. Patients also performed the Mini-Mental State Examination (MMSE); and their human leucocyte antigen HLA-DRB1 and apolipoprotein E (ApoE) genotypes were investigated. RESULTS: Patients with higher education were less likely (p < 0.05) to have cognitive deficits than those with lower education, even when controlling for other covariates. Other significant predictors of cognitive deficit were: age, Expanded Disability Status Scale (EDSS), Multiple Sclerosis Severity Scale (MSSS), and a progressive course. No significant association was found with the HLA-DRB1*15:01 or ApoE ε4 alleles. CONCLUSIONS: These results provide support to the use of education as a proxy of cognitive reserve in MS and stress the need to take into account education when approaching cognition in MS.
BACKGROUND: Recent data suggest that cognitive reserve modulates the adverse effects of multiple sclerosis (MS) pathology on cognitive functioning; however, the protective effects of education in MS are still unclear. OBJECTIVE: To explore education as an indicator of cognitive reserve, while controlling for demographic, clinical and genetic features. METHODS: A total of 419 MSpatients and 159 healthy comparison (HC) subjects underwent a comprehensive neuropsychological (NP) assessment, and answered the Hospital Anxiety and Depression Scale. Based on the HC data, MSpatients' NP scores were adjusted for sex, age and education; and the estimated 5(th) percentile (or 95(th) percentile, when appropriate) was used to identify any deficits. Patients also performed the Mini-Mental State Examination (MMSE); and their human leucocyte antigen HLA-DRB1 and apolipoprotein E (ApoE) genotypes were investigated. RESULTS:Patients with higher education were less likely (p < 0.05) to have cognitive deficits than those with lower education, even when controlling for other covariates. Other significant predictors of cognitive deficit were: age, Expanded Disability Status Scale (EDSS), Multiple Sclerosis Severity Scale (MSSS), and a progressive course. No significant association was found with the HLA-DRB1*15:01 or ApoE ε4 alleles. CONCLUSIONS: These results provide support to the use of education as a proxy of cognitive reserve in MS and stress the need to take into account education when approaching cognition in MS.
Authors: Eleni S Vasileiou; Angeliki G Filippatou; Daniela Pimentel Maldonado; Grigorios Kalaitzidis; Henrik Ehrhardt; Jeffrey Lambe; Shiv Saidha; Elias S Sotirchos; Ellen M Mowry; Peter A Calabresi; Kathryn C Fitzgerald Journal: Brain Date: 2021-12-31 Impact factor: 13.501