Deans' stroke musings: Brain reserve and cognitive reserve protect against cognitive decline over 4.5 years in MS

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, April 23, 2014

Brain reserve and cognitive reserve protect against cognitive decline over 4.5 years in MS

I bet the same theory would apply to surviving a stroke with better brain reserve. Have your doctor measure your brain reserve and calculate how large a stroke you can survive. Considering the size of mine I must have had a substantial reserve.
http://www.neurology.org/content/early/2014/04/18/WNL.0000000000000433.short

James F. Sumowski, PhD,
Maria A. Rocca, MD,
Victoria M. Leavitt, PhD,
Jelena Dackovic, MD,
Sarlota Mesaros, MD,
Jelena Drulovic, MD,
John DeLuca, PhD and
Massimo Filippi, MD

+Show Affiliations

Correspondence to Dr. Sumowski: jsumowski@kesslerfoundation.org

Published online before print April 18, 2014, doi: 10.1212/WNL.0000000000000433 Neurology 10.1212/WNL.0000000000000433

Abstract
Full Text (PDF)

Also available:
Data Supplement

Abstract

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, η_p² = 0.122), with larger MLBG protecting against decline. MLBG did not moderate memory decline (p = 0.234, η_p² = 0.039). Intellectual enrichment moderated decline in cognitive efficiency (p = 0.031, η_p² = 0.126) and memory (p = 0.037, η_p² = 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.