Prosperini Luca, Alcamisi Irene, Quartuccio Maria Esmeralda, Rossi Ilaria, Fortuna Deborah, Ruggieri Serena
Department of Neurosciences, S. Camillo-Forlanini Hospital, C.ne Gianicolense 87, 00152, Rome, Italy.
Department of Rehabilitation Sciences and Health Professions, Sapienza University, Via Cardarelli s.n.c, 01100, Viterbo, Italy.
Neurol Sci. 2023 Dec;44(12):4411-4420. doi: 10.1007/s10072-023-06951-1. Epub 2023 Jul 18.
Approximately two-thirds of patients with multiple sclerosis (MS) complain different degrees of balance dysfunction, but some of them are able to withstand considerable disease burden without an overt balance impairment. Here, we tested the hypothesis that brain and cognitive reserve lessen the effect of MS-related tissue damage on balance control.
We measured the postural sway of 148 patients and 74 sex- and age-matched healthy controls by force platform under different conditions reflecting diverse neuro-pathological substrates of balance dysfunction: eyes opened (EO), eyes closed (EC), and while performing the Stroop test, i.e., dual-task (DT). Lesion volumes on T2-hyperintense and T1-hypointense sequences, and normalized brain volume provided estimations of MS-related tissue damage in patients with MS. Hierarchical linear regressions explored the protective effect against the MS-related tissue damage of intracranial volume and educational attainment (proxies for brain and cognitive reserve, respectively) on balance.
Larger intracranial volume and high educational attainment mitigated the detrimental effect of MS-related tissue damage on postural sway under EO (adjusted-R=0.20 and 0.27, respectively, p<0.01) and DT (adjusted-R=0.22 and 0.30, respectively, p<0.06) conditions. Neither educational level nor brain size was associated with postural sway under EC condition.
Our findings suggest a protective role of brain and cognitive reserve even on balance, an outcome that relies on both motor control and higher order processing resources. The lack of a protective effect on postural sway under EC condition confirms that this latter outcome is closer associated with spinal cord rather than brain damage.
约三分之二的多发性硬化症（MS）患者存在不同程度的平衡功能障碍，但其中一些患者能够承受相当大的疾病负担而无明显的平衡损害。在此，我们检验了大脑和认知储备可减轻MS相关组织损伤对平衡控制影响的假设。
我们通过测力平台测量了148例患者和74例性别及年龄匹配的健康对照在不同条件下的姿势摆动，这些条件反映了平衡功能障碍的不同神经病理基础：睁眼（EO）、闭眼（EC）以及执行Stroop测试时，即双任务（DT）。T2高信号和T1低信号序列上的病变体积以及标准化脑体积提供了MS患者MS相关组织损伤的估计值。分层线性回归探讨了颅内体积和受教育程度（分别为大脑和认知储备的指标）对平衡的MS相关组织损伤的保护作用。
较大的颅内体积和高受教育程度减轻了MS相关组织损伤在EO（调整R分别为0.20和0.27，p<0.01）和DT（调整R分别为0.22和0.30，p<0.06）条件下对姿势摆动的有害影响。在EC条件下，受教育水平和脑大小均与姿势摆动无关。
我们的研究结果表明大脑和认知储备即使对平衡也具有保护作用，这一结果依赖于运动控制和高阶加工资源。在EC条件下对姿势摆动缺乏保护作用证实了后一种结果与脊髓而非脑损伤的关联更为密切。
