Article

OBJECTIVE: To investigate the possible buffering effect of cognitive reserve on
symptom experience for multiple sclerosis (MS) disease course. DESIGN: Secondary
analysis of longitudinal data from the North American Research Committee on MS
Registry. SETTING: Registry study and web-based supplemental survey.
PARTICIPANTS: People with MS (N=859). INTERVENTIONS: Not applicable. MAIN OUTCOME
MEASURES: Two health outcome measures, the Symptom Inventory and the Performance
Scales, were collected biannually over 1 and 6 years, respectively. Active and
passive cognitive reserve was measured using the Stern Leisure Activities and the
Sole-Padulles Childhood Enrichment tools, respectively. Linear regression,
chi-square, multilevel 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: Patients with
high-active reserve had a lesser symptom burden than those with low-active
reserve independent of passive reserve (P<.01). Cognitive reserve was associated
with course of disease, such that high-active patients were overrepresented among
relapsing-remitting patients, and underrepresented among patients with
progressive disease (chi(2)=14.7, P<.03). Longitudinal modeling revealed a
significant interaction of active reserve and time in mobility, fatigue, and
overall disability in the whole sample (P<.05 in all comparisons). Among patients
whose disability trajectories changed over time, active cognitive reserve was
associated with less deterioration (P<.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. CONCLUSIONS: Our 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 the disease
course of MS, providing a longer "runway" until disability accrual through
cortical remodeling. Loss of cognitive reserve may explain the onset of
progressive disease in MS.
CI - Copyright (c) 2013 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS