Cognitive reserve buffers against disability and progressive disease

Cognitive reserve more than a hypothesis; a buffer against progressive MS. #MSBlog #MSResearch

Epub: Schwartz et al. Cognitive reserve and symptom experience in multiple sclerosis: A buffer to disability progression over time? Arch Phys Med Rehabil. 2013 May 28.

OBJECTIVE: To investigate the possible buffering effect of cognitive reserve on symptom experience for MS disease course. Enhanced cognitive reserve is associated with better health and well-being in MS. Passive cognitive reserve reflects developed capacity, whereas active cognitive reserve reflects current enrichment activities.

DESIGN: Secondary analysis of longitudinal data (n=859) from the North American Research Committee on MS (NARCOMS) Registry. 

MAIN OUTCOME MEASURES: Two health outcome measures — the Symptom Inventory and the Performance Scales — were collected bi-annually over 1 and 6 years, respectively. Active and passive cognitive reserve were measured using the Stern Leisure Activities Sole-Padulles Childhood Enrichment tools, respectively. Linear regression, chi-square, multi-level random effects modeling, and classification and regression tree modeling were used to compare cross-sectional means, disease course by cognitive reserve, longitudinal trajectories, and active cognitive reserve item endorsement by disability groups, respectively.

RESULTS: High-active reserve MSers had lesser symptom burden than low active MSers independent of passive reserve (p<0.01). Cognitive reserve was associated with course of disease, such that high-active MSers were over-represented among relapsing-remitting MSers, and under-represented among MSers with progressive disease. Longitudinal modeling revealed that a significant interaction of active reserve and time in mobility, fatigue, and overall disability in the whole sample (p<0.05 in all comparisons). Among MSers whose disability trajectories changed over time, active cognitive reserve was associated with less deterioration (p<0.001). Passive cognitive reserve evidenced no effect in the longitudinal analyses. Active cognitive reserve scores across disability groups had a similar range but comprised different items, indicating that patients maintain active cognitive reserve with different activities as the disease progresses.

CONCLUSION: These findings suggest that active cognitive reserve is a buffer for functional limitation across disability groupings. Cognitive reserve may provide an alternative lens for thinking about MS course of disease, providing a longer “runway” until disability accrual through cortical remodeling. Loss of cognitive reserve may explain the onset of progressive disease in MS.

“This study supports a growing body of literature in the field of MS and other neurodegenerative diseases of how important cognitive reserve is in delaying the onset of progressive neurological dysfunction. The more reserve you have  the better. How do you increase you reserve? It appears to correlate with education and keeping your brain healthy.”

“Brain Health; what can we do? Foremost in MS is  being on an effective DMT to suppress all disease activity if possible; i.e. no evidence of disease activity (NEDA). In the future NEDA may include normalization of brain atrophy rates and spinal fluid neurofilament levels. Other things that may improve brain health are, exercise, diet, sleep, treatment of co-morbidties or other diseases, for example hypertension, diabetes, raised cholesterol levels, stopping smoking, brain training, reducing stress and anxiety.” 

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.


  • Really interesting, and heartening to think that there may be some things people can do to keep their brains healthy. I heard something similar on Radio 4 yesterday about how AgeUk have done work in his area, and found that exercise can help maintain brain function.

  • "Other things that may improve brain health are, exercise, diet, sleep… reducing stress and anxiety."

    Wowowow… This sounds a little "alternative"
    You bunch of hippies 🙂

  • G. can you please write a post on Brain health?

    diet, sleep cholesterol and brain training are particularly interesting as manageable in my view.


  • I second Tony's request. I'd like to read more credible information about brain health. That said, didn't a study come out recently showing that brain training (Luminosity, specifically) had no effect?

  • Do any of these studies on coognitive reserve suggest that taking up mental activities is protective? Can you top up your reserves, or are you reliant on whatever reserves you might happen to have built up before the onset of MS?

By Prof G



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