Friday, 25 April 2014

Clinic speak: brain reserve and cognitive decline

Protecting Brain: do we have a responsinility to protect your brain? #ClinicSpeak #MSBlog #MSResearch

"Protecting Brain! Do we have a responsibility to protect brain? Now that we have therapies that have an impact on end-organ damage, i.e. they delay or slow down brain volume loss should we be targeting this as an outcome in MS treatment?"
"The following study shows in MS, as has been shown for Alzheimer's disease, that brain reserve capacity protects you to the some extent from MS-related cognitive decline. Dare I refer to this problem as a preventable dementia? Apart from DMTs, in particular high-efficacy DMTs, is there anything else you can do to reduce cognitive decline? Yes, you should try and optimise your brain health. The lessons for you are the same general lessons that apply to the whole population. The following is a quick list I have put together:
  1. Exercise regularly if you can; aerobic exercise 3-4x per week.
  2. Improve your diet; I recommend the British Heart Foundation Diet or a Mediterranean diet
  3. 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. 
  4. Stop smoking.
  5. Improve your sleep hygiene.
  6. Review what drugs your are on; many of the drugs we prescribe to treat the symptoms of MS make cognitive impairment worse.
  7. Actively manage any co-morbidities you may have, in particular high blood pressure, diabetes, obesity and high cholesterol.
  8. 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.
  9. 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.
If you have cognitive problems already you may want to enrol in a cognitive rehabilitation programme. If this is not possible you could try the on-line programme, Staying Smart, that the MS Trust run."

From Alzheimer's treatment and prevention.

OBJECTIVE: Based on the theories of brain reserve and cognitive reserve, we investigated whether larger maximal lifetime brain growth (MLBG) and/or greater lifetime intellectual enrichment protect against cognitive decline over time.

METHODS: Forty MSers underwent baseline and 4.5-year follow-up evaluations of cognitive efficiency (Symbol Digit Modalities Test, Paced Auditory Serial Addition Task) and memory (Selective Reminding Test, Spatial Recall Test). Baseline and follow-up MRIs quantified disease progression: percentage brain volume change (cerebral atrophy), percentage change in T2 lesion volume. MLBG (brain reserve) was estimated with intracranial volume; intellectual enrichment (cognitive reserve) was estimated with vocabulary. We performed repeated-measures analyses of covariance to investigate whether larger MLBG and/or greater intellectual enrichment moderate/attenuate cognitive decline over time, controlling for disease progression.

RESULTS: MSers declined in cognitive efficiency and memory (p < 0.001). MLBG moderated decline in cognitive efficiency (p = 0.031, ηp2= 0.122), with larger MLBG protecting against decline. MLBG did not moderate memory decline (p = 0.234, ηp2 = 0.039). Intellectual enrichment moderated decline in cognitive efficiency (p = 0.031, ηp2 = 0.126) and memory (p = 0.037, ηp2 = 0.115), with greater intellectual enrichment protecting against decline. MS disease progression was more negatively associated with change in cognitive efficiency and memory among MSers with lower vs higher MLBG and intellectual enrichment.

CONCLUSION: We provide longitudinal support for theories of brain reserve and cognitive reserve in MS. Larger MLBG protects against decline in cognitive efficiency, and greater intellectual enrichment protects against decline in cognitive efficiency and memory. Consideration of these protective factors should improve prediction of future cognitive decline in patients with MS.


  1. This is good news for me because my (retirement) life is based round trying to do all those things. It's cost me a few friendships but I walk away from any stressful situation and try and pack in as much exercise and as many holidays as I can. Top of my past stressful situations was dealing with inadequate medical care: the trouble is that an MSer may be feeling too ill to confront these situations. Without good care, the illness is totally overwhelming.

  2. And good news for me too. I do all these things and have done so for many years. The hardest part for me is getting stress under control but meditation, mountain climbing, fast-paced daily walking all seem to help with this, along with my good friend Marcus Aurelius: “If you are distressed by anything external, the pain is not due to the thing itself but to your own estimate of it; and this you have the power to revoke at any moment.” It works for me, anyway :)


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