Tuesday, 19 April 2016

Common sense is not so common - the role of education in cognition

Front Neurol. 2016 Mar 29;7:46. doi: 10.3389/fneur.2016.00046. eCollection 2016.

Influence of Formal Education on Cognitive Reserve in Patients with Multiple Sclerosis.

Luerding R, Gebel S, Gebel EM, Schwab-Malek S, Weissert R.

Abstract

The 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). 

12 comments:

  1. Really pleased to read this post. I didn't go to university, but have kept much of my cognitive function. My job was challenging and meant I was constantly learning new things and it also involved complex problem solving on a daily basis.

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    1. Hope more people read it and realise how much more can be done.

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  2. Am a great believer in life long learning. I struggled to start anything new since my diagnosis, I kept thinking that it wasn't worth it. However, I started a machine learning course a couple of weeks ago and am enjoying it.

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  3. Very interesting text because in practice we observe other MSers is that those who manage to keep a rhythm of physical and mental activities do seem to do better, even managing to recover without many compromises their outbreaks...

    I myself, for example, I always try to keep myself physically active (at home, at work, at the gym, etc.) and the Blog even encourages me to read content that is completely different from my work (I'm a lawyer), my day by day, and it definitely takes my brain to work, remember concepts I still saw in the course of biology, and this is very good...

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    1. I hear things are getting "interesting" in Brazil at the moment, Cinara.
      Sounds grim.

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    2. At thios time they're things here aren't at all "interesting"... "President Dilma Rousseff leaves or isn't?

      In Brazil, or better in portuguese language, we use the adjective "interesting" when something "arouses interest, or motivation, or when it reveals useful".
      But if the Usual English this sounds unpleasant I'll stop using it...

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  4. Certainly it is important to live a healthy life, both mentally and physically. But we should not come to the conclusion that MSers are somehow responsible for their condition because they are or were not active enough. I know this is not the context of this post.

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    1. Agree. In fact this applies to everyone, I've been utilising this since I became aware of it.

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  5. (I posted this earlier but it didn't get published for whatever reason).Do you think that high levels of brain activity can over-ride some symptoms? I recently completed a very hard language immersion course of 25 hours during and after which for 30 days had no sensory symptoms (they are normally on a daily basis).

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  6. What your alluding to there is something which is now classed cognitive behavioural therapy; I don't know if anyone has looked at the scientific basis of it. Ideally by focusing on other matters a person is able to reduce their symptoms.

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