German Centre for Neurodegenerative Diseases (DZNE), Rostock, Germany.
German Centre for Neurodegenerative Diseases (DZNE), Rostock, Germany; Department of Neurology, University of Rostock, Rostock, Germany.
Cortex. 2021 Jun;139:240-248. doi: 10.1016/j.cortex.2021.03.005. Epub 2021 Mar 17.
We investigated whether cognitive reserve measured by education and premorbid IQ allows amyotrophic lateral sclerosis patients to compensate for regional brain volume loss.
This was a cross-sectional study. We recruited sixty patients with amyotrophic lateral sclerosis from two specialist out-patient clinics. All participants underwent neuropsychological assessment; the outcomes were standardized z-scores reflecting verbal fluency, executive functions (shifting, planning, working memory), verbal memory and visuo-constructive ability. The predictor was regional brain volume. The moderating proxies of cognitive reserve were premorbid IQ (estimated by vocabulary) and educational years. We hypothesized that higher cognitive reserve would correlate with better performance on a cognitive test battery, and tested this hypothesis with Bayesian analysis of covariance.
The analyses provided moderate to very strong evidence in favor of our hypothesis with regard to verbal fluency functions, working memory, verbal learning and recognition, and visuo-constructive ability (all BF > 3): higher cognitive reserve was associated with a mild increase in performance. For shifting and planning ability, the evidence was anecdotal.
These results indicate that cognitive reserve moderates the effect of brain morphology on cognition in ALS. Patients draw small but meaningful benefits from higher reserve, preserving fluency, memory and visuo-constructive functions. Executive functions presented a dissociation: verbally assessed functions benefitted from cognitive reserve, non-verbally assessed functions did not. This motivates future research into cognitive reserve in ALS and practical implications, such as strengthening reserve to delay decline.
我们研究了认知储备（通过教育和术前智商来衡量）是否能使肌萎缩侧索硬化症患者补偿大脑区域体积的损失。
这是一项横断面研究。我们从两个专家门诊招募了 60 名肌萎缩侧索硬化症患者。所有参与者都接受了神经心理学评估；结果为反映语言流畅性、执行功能（转换、计划、工作记忆）、语言记忆和视觉构建能力的标准 z 分数。预测因子是大脑区域体积。认知储备的调节变量是术前智商（用词汇来估计）和受教育年限。我们假设较高的认知储备与认知测试组合上的更好表现相关，并通过协方差的贝叶斯分析来检验这一假设。
分析结果为我们的假设提供了中度到非常强的证据，这些假设涉及语言流畅性、工作记忆、语言学习和识别以及视觉构建能力（所有 BF>3）：较高的认知储备与表现的轻微提高相关。对于转换和计划能力，证据只是传闻。
这些结果表明，认知储备调节了大脑形态对肌萎缩侧索硬化症认知的影响。患者从较高的储备中获得了微小但有意义的益处，从而保持了语言流畅性、记忆和视觉构建功能。执行功能表现出一种分离：通过言语评估的功能受益于认知储备，而非言语评估的功能则不受影响。这激发了对肌萎缩侧索硬化症认知储备的未来研究和实际意义，例如加强储备以延缓衰退。
