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Patient Cognitive Reserve and MS-Related Cognitive Dysfunction

Patient Cognitive Reserve and MS-Related Cognitive Dysfunction. Chair Timothy L. Vollmer, MD Faculty John DeLuca, PhD. Study Rationale and Objective. Introduction Cognitive impairment affects approximately 2/3 of patients with MS

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Patient Cognitive Reserve and MS-Related Cognitive Dysfunction

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  1. Patient Cognitive Reserve and MS-Related Cognitive Dysfunction Chair Timothy L. Vollmer, MD Faculty John DeLuca, PhD

  2. Study Rationale and Objective • Introduction • Cognitive impairment affects approximately 2/3 of patientswith MS • MS-related cognitive dysfunction is only partially predicted by MRI estimates of brain pathology • Study objective • To determine whether higher premorbid intellectual functioning, ie, cognitive reserve (efficiency and capacity of neural networks), protects patients from MS-related cognitive dysfunction • Cognitive reserve is best measured on the basis of estimated verbal intelligence as determined on the Wide Range Achievement Test–Third Edition • Lower cognitive reserve: Z = -1; higher cognitive reserve: Z = +1 Sumowski JF, et al. J Clin Exp Neuropsychol. 2009;31:913-926.

  3. Components of Cognitive FunctionMeasurement Tools • Simple processing efficiency • Symbol Digit Modalities Test (SDMT) – Oral Version • Complex information processing efficiency • Paced Auditory Serial Addition Test (PASAT) • Verbal learning and memory • Logical Memory subtests (LM-I and LM-II) of the Wechsler Memory Scale–Revised • Verbal learning: LM-I • Verbal memory: LM-II Sumowski JF, et al. J Clin Exp Neuropsychol. 2009;31:913-926.

  4. Simple Processing Efficiency Total Cognitive Reserve Group Lower Higher Z scoreZ score (Percentile)Z score (Percentile) Healthy controls +0.48 + 0.89 +0.57* (72nd) +0.46* (68th) MS patients -0.58 + 1.18 -1.16†(12th) -0.26† (40th) P value <.001 * The correlation between cognitive reserve and simple processing efficiency did not reach significance in healthy controls (r = -.01, P >.50). † The correlation between cognitive reserve and simple processing efficiency did not reach significance in MS patients (r = 21, P >.10). Sumowski JF, et al. J Clin Exp Neuropsychol. 2009;31:913-926.

  5. Complex Information Processing Efficiency Total Cognitive Reserve Group Lower Higher Z scoreZ score (Percentile)Z score (Percentile) Healthy controls +0.21 + 0.84 +0.06* (52nd) +0.29* (61st) MS patients -0.50 + 1.13 -1.56† (6th) -0.20† (58th) P Value .001 • The correlation between cognitive reserve and complex information processing efficiency • (PASAT) did not reach significance in healthy controls (r = .15, P >.10). • † There was a large significant correlation between cognitive reserve and complex • information processing efficiency (PASAT) in MS patients (r = .42, P = .001). Sumowski JF, et al. J Clin Exp Neuropsychol. 2009;31:913-926.

  6. Verbal Learning Total Cognitive Reserve Group Lower Higher Z scoreZ score (Percentile)Z score (Percentile) Healthy controls +0.57 + 0.84 0.23* (59th) +0.60* (73rd) MS patients -0.01 + 0.81 -1.25† (11th) +0.78† (78th) P value <.001 * The correlation between cognitive reserve and verbal learning did not reach significance in healthy controls (r = .14, P >.10). † There was a large significant correlation between cognitive reserve and verbal learning in MS patients (r = .61, P <.001). Sumowski JF, et al. J Clin Exp Neuropsychol. 2009;31:913-926.

  7. Verbal Memory Total Cognitive Reserve Group Lower Higher Z scoreZ score (Percentile)Z score (Percentile) Healthy controls +0.53 + 0.83 +0.09* (54th) +0.63* (74th) MS patients -0.12 + 0.87 -1.23† (11th) +0.63† (74th) P value <.001 * The correlation between cognitive reserve and verbal memory did not reach significance in healthy controls (r = .22, P >.10). † There was a large significant correlation between cognitive reserve and verbal memory in MS patients (r = .53, P <.001). Sumowski JF, et al. J Clin Exp Neuropsychol. 2009;31:913-926.

  8. Conclusions • The detrimental effect of MS on aspects of cognitive functioning is modified by patient cognitive reserve • Higher cognitive reserve protects patients from MS-related complex information processing inefficiency and verbal learning and verbal memory deficits • The protective effect of higher cognitive reserve allows patients to maintain cognitive performance comparable to that of healthy controls • However, higher cognitive reserve had no significant effect on MS-related deficits in simple processing efficiency • These findings may help to explain the weak association between MRI markers of MS brain pathology and cognition noted in previous studies Sumowski JF, et al. J Clin Exp Neuropsychol. 2009;31:913-926.

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