“The big R in MS is for RESERVE as in reserve capacity. It seems as if the same factors that protect the general population from developing Alzheimer’s disease also protect MSers getting MS-related dementia; one is cognitive reserve. It is known in the dementia field that higher education protects you from developing age-related dementia. In the study below reports a similar observation in MS; MSers with higher education have less cognitive deficits than MSers without higher education.”
“MSers reading this post who have progressive MS will say what about me? If you have been following this blog for sometime you will have heard me talk about combination therapies, therapeutic lag, asynchronous progressive MS and the length-dependent axonopathy hypothesis. I truly believe that if I am correct regarding these observations it will lead to effective treatments for progressive MS. We haven’t given up on you; we have to step back, pause, learn from our mistakes and try new strategies.”
- Exercise regularly if you can; aerobic exercise 3-4x per week.
- Improve your diet; I recommend the British Heart Foundation Diet or a Mediterranean diet
- Keep yourself mentally active; I am not sure that the evidence of brain training is robust enough to be prescribed to MSers, but it makes sense.
- Stop smoking.
- Improve your sleep hygiene.
- Review what drugs your are on; many of the drugs we prescribe to treat the symptoms of MS make cognitive impairment worse.
- Actively manage any co-morbidities you may have, in particular high blood pressure, diabetes, obesity and high cholesterol.
- Depression, low mood, anxiety and stress; if you are depressed or anxious please seek advice and treatment. Depression and anxiety affects cognitive function. Try and manage levels of stress.
- Invest in social capital; keep working on your relationships with your family and friends. Social isolation is not good for cognitive functioning and the factors that impact on cognition.
Epub: Martins Da Silva et al. Cognitive reserve in multiple sclerosis: Protective effects of education. Mult Scler. 2015. pii: 1352458515581874.
BACKGROUND: Recent data suggest that cognitive reserve modulates the adverse effects of 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 MSers 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, MSers’ NP scores were adjusted for sex, age and education; and the estimated 5th percentile (or 95th percentile, when appropriate) was used to identify any deficits. MSers also performed the Mini-Mental State Examination (MMSE); and their human leucocyte antigen HLA-DRB1 and apolipoprotein E (ApoE) genotypes were investigated.
RESULTS: MSers 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.