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May 7, 2013

Cognitive reserve and cortical atrophy in multiple sclerosis
A longitudinal study

Maria Pia Amato, MD, Lorenzo Razzolini, MD, Benedetta Goretti, PhD, Maria Laura Stromillo, MD, Francesca Rossi, MD, Antonio Giorgio, MD, Bahia Hakiki, MD, Marta Giannini, MD, Luisa Pastò, MD, Emilio Portaccio, MD, and Nicola De Stefano, MDAuthors Info & Affiliations
May 7, 2013 issue
80 (19) 1728-1733
https://doi.org/10.1212/WNL.0b013e3182918c6f
Letters to the Editor
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Abstract

Objective:

To test the cognitive reserve (CR) hypothesis in the model of multiple sclerosis (MS) by assessing the interactions among CR, brain atrophy, and cognitive efficiency in patients with relapsing-remitting MS.

Methods:

A Cognitive Reserve Index was calculated including education, premorbid leisure activities, and IQ. Brain atrophy was assessed through magnetic resonance quantitative parameters of normalized total brain volume and normalized cortical volume. Cognitive function was measured using Rao's Brief Repeatable Battery.

Results:

Fifty-two patients with relapsing-remitting MS were evaluated at baseline and 35 of them were reassessed after a 1.6-year follow-up period. At baseline, higher CR predicted better performance on most of the Brief Repeatable Battery tests, independent of brain atrophy and clinical and demographic characteristics (p ≤ 0.021). An interaction between CRI and normalized cortical volume predicted better cognitive performance on tasks of verbal memory and attention/information processing speed (p < 0.005). However, at the follow-up examination, progressing cortical atrophy (β = 0.45; p = 0.008) and older age (β = −0.33; p = 0.044) were the only predictors of deteriorating cognitive performance.

Conclusions:

Our findings suggest that higher CR in individuals with MS may mediate between cognitive performance and brain pathology. CR-related compensation may, however, fail with progression of damage. The time window of opportunity for therapeutic approaches aimed at intellectual enhancement most likely lies in the earliest disease stages.

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Information & Authors

Information

Published In

Neurology®
Volume 80 • Number 19 • May 7, 2013
Pages: 1728-1733
PubMed: 23576622

Copyright

© 2013 American Academy of Neurology.

Publication History

Received: August 8, 2012
Accepted: January 2, 2013
Published in print: May 7, 2013
Published online: September 26, 2023

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Authors

Affiliations & Disclosures

Maria Pia Amato, MD
From the Department of Neurology (M.P.A., L.R., B.G., B.H., M.G., L.P., E.P.), University of Florence; Don Gnocchi Foundation (L.R., B.H., E.P.), Florence; and Department of Neurological and Behavioural Sciences (M.L.S., F.R., A.G., N.D.S.), University of Siena, Italy.
Disclosure
Scientific Advisory Boards:
1.
member of the Advisory Board, Biogen-Idec, Merck Serono, Bayer Schering, Teva, Novartis and Sanofi Aventis
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
honoraria for speaking from Biogen-Idec, Merck Serono, Bayer Schering, Novartis, Teva and Sanofi Aventis
Editorial Boards:
1.
Member of Editorial Board and Associate Editor of BMC Neurology
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
research grants from Biogen Idec, Merk Serono, Bayer Shering, Sanophi Aventis, Teva
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Lorenzo Razzolini, MD
From the Department of Neurology (M.P.A., L.R., B.G., B.H., M.G., L.P., E.P.), University of Florence; Don Gnocchi Foundation (L.R., B.H., E.P.), Florence; and Department of Neurological and Behavioural Sciences (M.L.S., F.R., A.G., N.D.S.), University of Siena, Italy.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
Funding for travel to Scientific Congresses by Novartis
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
one research grant by Novartis
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Benedetta Goretti, PhD
From the Department of Neurology (M.P.A., L.R., B.G., B.H., M.G., L.P., E.P.), University of Florence; Don Gnocchi Foundation (L.R., B.H., E.P.), Florence; and Department of Neurological and Behavioural Sciences (M.L.S., F.R., A.G., N.D.S.), University of Siena, Italy.
Disclosure
Scientific Advisory Boards:
1.
Dr. Goretti serves on a scientific advisory board for Biogen
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
Dr. Goretti receives honoraria for speaking from Biogen, Teva and Novartis
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
Dr. Goretti receives research support from Biogen, Merck, Novartis
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Maria Laura Stromillo, MD
From the Department of Neurology (M.P.A., L.R., B.G., B.H., M.G., L.P., E.P.), University of Florence; Don Gnocchi Foundation (L.R., B.H., E.P.), Florence; and Department of Neurological and Behavioural Sciences (M.L.S., F.R., A.G., N.D.S.), University of Siena, Italy.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Francesca Rossi, MD
From the Department of Neurology (M.P.A., L.R., B.G., B.H., M.G., L.P., E.P.), University of Florence; Don Gnocchi Foundation (L.R., B.H., E.P.), Florence; and Department of Neurological and Behavioural Sciences (M.L.S., F.R., A.G., N.D.S.), University of Siena, Italy.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Antonio Giorgio, MD
From the Department of Neurology (M.P.A., L.R., B.G., B.H., M.G., L.P., E.P.), University of Florence; Don Gnocchi Foundation (L.R., B.H., E.P.), Florence; and Department of Neurological and Behavioural Sciences (M.L.S., F.R., A.G., N.D.S.), University of Siena, Italy.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Bahia Hakiki, MD
From the Department of Neurology (M.P.A., L.R., B.G., B.H., M.G., L.P., E.P.), University of Florence; Don Gnocchi Foundation (L.R., B.H., E.P.), Florence; and Department of Neurological and Behavioural Sciences (M.L.S., F.R., A.G., N.D.S.), University of Siena, Italy.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Marta Giannini, MD
From the Department of Neurology (M.P.A., L.R., B.G., B.H., M.G., L.P., E.P.), University of Florence; Don Gnocchi Foundation (L.R., B.H., E.P.), Florence; and Department of Neurological and Behavioural Sciences (M.L.S., F.R., A.G., N.D.S.), University of Siena, Italy.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Luisa Pastò, MD
From the Department of Neurology (M.P.A., L.R., B.G., B.H., M.G., L.P., E.P.), University of Florence; Don Gnocchi Foundation (L.R., B.H., E.P.), Florence; and Department of Neurological and Behavioural Sciences (M.L.S., F.R., A.G., N.D.S.), University of Siena, Italy.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Emilio Portaccio, MD
From the Department of Neurology (M.P.A., L.R., B.G., B.H., M.G., L.P., E.P.), University of Florence; Don Gnocchi Foundation (L.R., B.H., E.P.), Florence; and Department of Neurological and Behavioural Sciences (M.L.S., F.R., A.G., N.D.S.), University of Siena, Italy.
Disclosure
Scientific Advisory Boards:
1.
Dr. Portaccio serves on a scientific advisory board for Biogen-Idec, Merck Serono and Bayer
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
Honoraria and research grants from Merck Serono, Biogen Dompè, Bayer Schering, Sanofi Aventis, Teva
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Nicola De Stefano, MD
From the Department of Neurology (M.P.A., L.R., B.G., B.H., M.G., L.P., E.P.), University of Florence; Don Gnocchi Foundation (L.R., B.H., E.P.), Florence; and Department of Neurological and Behavioural Sciences (M.L.S., F.R., A.G., N.D.S.), University of Siena, Italy.
Disclosure
Scientific Advisory Boards:
1.
Prof. N. De Stefano serves on scientific advisory boards for Merck- Serono.
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
Travel expense refunds from Teva and Merck-Serono.
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
Honoraria for lectures from Teva, BioMS, Biogen-Idec, Bayer Schering Pharma and Merck-Serono.
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author

Notes

Correspondence to Prof. Amato: [email protected]
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

Author Contributions

Prof. Amato: drafting/revising the manuscript for content, including medical writing; study concept and design; analysis and interpretation of data; study supervision and coordination. Dr. Razzolini: data collection; drafting/revising the manuscript for content, including medical writing; analysis and interpretation of data. Dr. Goretti: neuropsychological data collection; drafting/revising the manuscript for content, including medical writing; analysis and interpretation of data. Dr. Stromillo, Dr. Rossi, and Dr. Giorgio: MRI data collection; drafting/revising the manuscript for content, including medical writing; analysis and interpretation of data. Dr. Hakikia, Dr. Giannini, and Dr. Pastò: data collection; drafting/revising the manuscript for content, including medical writing; analysis and interpretation of data. Dr. Portaccio: data collection; drafting/revising the manuscript for content, including medical writing; statistical analysis; study design; analysis and interpretation of data. Prof. De Stefano: drafting/revising the manuscript for content, including medical writing; study concept and design; analysis and interpretation of data; coordination of MRI data collection and interpretation.

Disclosure

M.P. Amato serves on scientific advisory boards for Biogen-Idec, Merck Serono, Bayer Schering, Teva, and Sanofi-Aventis and receives research support and honoraria for speaking from Biogen-Idec, Merck Serono, Bayer Schering, Teva, Novartis, and Sanofi-Aventis. L. Razzolini has received research support from Novartis. B. Goretti has received research support from Biogen-Idec, Merck Serono, Bayer Schering, Teva, and Sanofi-Aventis and receives honoraria for speaking from Biogen-Idec and Teva. M.L. Stromillo, F. Rossi, and A. Giorgio report no disclosures. B. Hakiki receives research support from Merck Serono and Novartis. M. Giannini and L. Pastò report no disclosures. E. Portaccio serves on scientific advisory boards for Biogen-Idec, Merck Serono, and Bayer Schering and receives research support and honoraria for speaking from Biogen-Idec, Merck Serono, Bayer Schering, Teva, Novartis, and Sanofi-Aventis. N. De Stefano serves on a scientific advisory board for Merck Serono; has received funding for travel from Teva Pharmaceutical Industries Ltd. and Merck Serono; has received speaker honoraria from Teva Pharmaceutical Industries Ltd., BioMS Medical, Biogen-Dompé AG, Bayer Schering Pharma, and Merck Serono; and receives research support from the Italian MS Society. Go to Neurology.org for full disclosures.

Study Funding

No targeted funding reported.

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    Abstract
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