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Sub-threshold cognitive impairment in multiple sclerosis: the association with cognitive reserve

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Abstract

Multiple sclerosis (MS) patients with high premorbid intellect have the advantage of cognitive reserve that may mitigate the effects of cognitive decline. A fall-off in cognition may nevertheless still occur, even should it fail to meet global impairment thresholds. The present cross-sectional study explores the neurologic and behavioral characteristics of this little known group of patients. A consecutive sample of 144 MS patients underwent neuropsychological testing with the minimal assessment of cognitive function in the MS (MACFIMS) battery. Premorbid IQ was assessed with the ANART reading test. A validated algorithm based on ANART errors and verbal fluency scores was used to predict whether current cognitive function matched premorbid estimates. Three MS groups were thus defined: cognitively intact (n = 53), impaired (n = 46) and cognitively intact on the MACFIMS, but falling short of premorbid predictions (n = 45). Patients who were cognitively intact on the MACFIMS but fell short of verbal fluency predictions had higher premorbid IQ (p = 0.007) and lower EDSS (p = 0.002) than cognitively impaired, but not intact patients. They outperformed impaired patients on every MACFIMS variable, but were more impaired than intact patients on the Paced Auditory Serial Addition Test-3 (PASAT-3) (p = 0.009). They were more likely to be employed (48.9 %) than the impaired (26.1 %) group (p = 0.025). We defined a group of MS patients deemed cognitively intact on conventional neuropsychological testing, but who, nevertheless, had deficits relative to premorbid intellectual abilities. The high premorbid IQ in this group does not prevent, but ‘softens’ the impact of cognitive decline. These findings provide novel evidence supporting cognitive reserve as a protective factor in relation to cognitive dysfunction in MS.

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Acknowledgments

The authors thank Liesly Lee, MD (Sunnybrook Health Sciences Centre), Kathleen Carr, RN (Sunnybrook Health Sciences Centre), and Sheryl Clarke, RN, BSN, M.Ed. (St. Michael’s Hospital) for assisting with recruitment and Kimia Honarmand for assisting with data collection. This study was funded by the Multiple Sclerosis Society of Canada.

Conflicts of interest

Dr. Feinstein has served on scientific advisory boards for Merck Serono and Avanir Pharmaceuticals; has received speaker honoraria from Merck Serono, Teva Pharmaceutical Industries Ltd., Bayer Schering Pharma, and Biogen Idec; serves on the editorial boards of Multiple Sclerosis and the African Journal of Psychiatry; receives publishing royalties for The Clinical Neuropsychiatry of Multiple Sclerosis (Cambridge University Press, 2007); chairs the Medical Advisory Committee for the Multiple Sclerosis Society of Canada; conducts neuropsychiatric evaluation, cognitive testing, brain imaging in neuropsychiatry in his clinical practice; and receives research support from the Canadian Institute of Health Research, the Multiple Sclerosis Society of Canada and Teva Pharmaceutical Industries Ltd.

H. Lapshin has received support from an Ontario Graduate Scholarship grant.

Dr. O’Connor serves on scientific advisory boards for Novartis, Sanofi-Aventis, Bayer Schering Pharma, Genentech, Inc., and Roche; has received speaker honoraria from Biogen Idec, Teva Pharmaceutical Industries Ltd., Novartis, and Sanofi-Aventis; has served as a consultant for Biogen Idec, Actelion Pharmaceuticals Ltd., Bayer Schering Pharma, EMD Serono, Inc., Teva Pharmaceutical Industries Ltd., Genentech Inc., and Warburg Pincus; has received research support from Abbott, Bayer Schering Pharma, Novartis, BioMS Medical, Sanofi-Aventis, CIS Pharma, Genmab A/S, Cognosci, Inc., Wyeth, Daiichi Sankyo, and Roche; and serves as the National Scientific and Clinical Advisor to the MS Society of Canada.

Dr. Lanctôt has received research support and/or speaker’s honoraria from Abbott Laboratories, Lundbeck Canada Inc., Pfizer Canada Inc., Janssen Ortho, MedImmune, and Wyeth.

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Authors and Affiliations

  1. Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Toronto, ON, M4N 3M5, Canada

    Anthony Feinstein, Helen Lapshin & Krista L. Lanctôt

  2. University of Toronto, 27 King’s College Circle, Toronto, ON, M5S 1A1, Canada

    Anthony Feinstein, Helen Lapshin, Paul O’Connor & Krista L. Lanctôt

  3. Neurology, St. Michael’s Hospital, 30 Bond St., Toronto, ON, M5B 1W8, Canada

    Paul O’Connor

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  1. Anthony Feinstein
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  2. Helen Lapshin
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  3. Paul O’Connor
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  4. Krista L. Lanctôt
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Correspondence to Anthony Feinstein.

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Feinstein, A., Lapshin, H., O’Connor, P. et al. Sub-threshold cognitive impairment in multiple sclerosis: the association with cognitive reserve. J Neurol 260, 2256–2261 (2013). https://doi.org/10.1007/s00415-013-6952-9

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  • DOI: https://doi.org/10.1007/s00415-013-6952-9

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