Influence of Formal Education on Cognitive Reserve in Patients with Multiple Sclerosis.
Luerding R, Gebel S, Gebel EM, Schwab-Malek S, Weissert R.
AbstractThe concept of cognitive reserve (CR) and its influence on cognitive impairment has attracted increasing interest. One hundred twenty-eight patients with multiple sclerosis (MS) from Southern Germany were evaluated during the years 2000 to 2012. Twenty-seven neuropsychological (NP) tests were applied regarding basic cognitive functions, attention, executive functions, visual perception and construction, memory and learning, problem solving, and language. By this retrospective approach, a comprehensive NP profile of the investigated individuals was established. An effect of timespan of formal education on CR was observed. Enrichment by reading, physical activities, and challenging vocational practices had more profound effects in patients who had undergone a shorter educational period compared to a longer educational period. In summary, our study demonstrates that the advantage of longer formal education periods, compared to shorter formal education periods, can be counterbalanced by high frequencies of reading, physical activities, and challenging vocational practices in patients with MS.
I am strong advocate of the 'use it or loose it' ideology in maintaining brain plasticity, and counsel my patients on a more active and engaged lifestyle to buffer against early cognitive decline. I check this regularly on follow up visits (annoying I admit!), but there is a method to the madness...
Cognitive reserve as a concept has been a force de rigueur in Alzheimer's management for some time. It refers to both the brain reserve capacity, which is determined by brain's neuronal count, synapses etc. and determines how much damage can be sustained (for example, in the case of a large stroke, recovery is determined by how much brain tissue is left), and also to an active reserve that is individualistic and depends on what strategies/capability the brain has available to cope with the injury. The latter is influenced by educational level (school vs. university), occupation/professional lifestyle and participation in activities that stimulate the brain as well as augment physical well-being.
Here the authors conclude that duration of formal education influences cognitive reserve in PwMS. Those with the longest period in formal education performed better with regard to learning and memory, executive function (how you get things done), basic cognitive tasks, problem solving and language. Those who spent a limited period in formal education could achieve better performance, however, through reading, physical activity and challenging occupations. Those who read challenging material on a regular basis had added benefits in term of learning, memory and problem solving, and language. Equally, those whose exercise regimen was strenuous/challenging could augment this further.
So why is education important? Education over time allows the person to accumulate the skills needed for compensation, leading to a higher cognitive reserve. In principal, this can also be counterbalanced by activities that increase the active reserve (i.e. greater frequency of reading, physical and mental activity, and a challenging vocation).