脑储备和认知储备可预防 MS 患者在 4.5 年内认知能力下降。
Brain reserve and cognitive reserve protect against cognitive decline over 4.5 years in MS.
机构信息
From Neuropsychology and Neuroscience (J.F.S., J. DeLuca), Kessler Foundation Research Center, West Orange; Rutgers (J.F.S., J. DeLuca), New Jersey Medical School, Newark, NJ; Neuroimaging Research Unit (M.A.R., M.F.) and Department of Neurology (M.A.R., M.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Manhattan Memory Center (V.M.L.), New York, NY; and Clinic of Neurology (J. Dackovic, S.M., J. Drulovic), Faculty of Medicine, University of Belgrade, Serbia.
出版信息
Neurology. 2014 May 20;82(20):1776-83. doi: 10.1212/WNL.0000000000000433. Epub 2014 Apr 18.
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 patients with multiple sclerosis (MS) 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
Patients with MS declined in cognitive efficiency and memory (p < 0.001). MLBG moderated decline in cognitive efficiency (p = 0.031, ηp (2) = 0.122), with larger MLBG protecting against decline. MLBG did not moderate memory decline (p = 0.234, ηp (2) = 0.039). Intellectual enrichment moderated decline in cognitive efficiency (p = 0.031, ηp (2) = 0.126) and memory (p = 0.037, ηp (2) = 0.115), with greater intellectual enrichment protecting against decline. MS disease progression was more negatively associated with change in cognitive efficiency and memory among patients 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.
目的
基于大脑储备和认知储备理论，我们研究了一生中大脑最大生长（MLBG）和/或智力积累是否会随着时间的推移保护认知能力下降。
方法
40 名多发性硬化症（MS）患者接受了认知效率（符号数字模态测试、Paced Auditory Serial Addition Task）和记忆（选择性提醒测试、空间回忆测试）的基线和 4.5 年随访评估。基线和随访 MRI 量化了疾病进展：脑容量变化百分比（脑萎缩）、T2 病变体积变化百分比。颅内体积估计 MLBG（大脑储备）；词汇量估计智力积累（认知储备）。我们进行了重复测量方差分析，以研究更大的 MLBG 和/或更大的智力积累是否随着时间的推移调节/减轻认知能力下降，同时控制疾病进展。
结果
MS 患者的认知效率和记忆下降（p < 0.001）。MLBG 调节认知效率下降（p = 0.031，ηp（2）= 0.122），较大的 MLBG 可防止下降。MLBG 不调节记忆下降（p = 0.234，ηp（2）= 0.039）。智力积累调节认知效率下降（p = 0.031，ηp（2）= 0.126）和记忆下降（p = 0.037，ηp（2）= 0.115），较大的智力积累可防止下降。与 MLBG 和智力积累较低的患者相比，MS 疾病进展与认知效率和记忆变化的相关性更强。
结论
我们为 MS 中的大脑储备和认知储备理论提供了纵向支持。较大的 MLBG 可防止认知效率下降，而更大的智力积累可防止认知效率和记忆下降。考虑这些保护因素应能提高对 MS 患者未来认知能力下降的预测。
Zotero 插件