title: Intellectual enrichment lessens the effect of brain atrophy on learning and memory in multiple sclerosis.
abstract: OBJECTIVE
  Learning and memory impairments are prevalent among persons with multiple sclerosis (MS); however, such deficits are only weakly associated with MS disease severity (brain atrophy). The cognitive reserve hypothesis states that greater lifetime intellectual enrichment lessens the negative impact of brain disease on cognition, thereby helping to explain the incomplete relationship between brain disease and cognitive status in neurologic populations. The literature on cognitive reserve has focused mainly on Alzheimer disease. The current research examines whether greater intellectual enrichment lessens the negative effect of brain atrophy on learning and memory in patients with MS.
  
  
  METHODS
  Forty-four persons with MS completed neuropsychological measures of verbal learning and memory, and a vocabulary-based estimate of lifetime intellectual enrichment. Brain atrophy was estimated with third ventricle width measured from 3-T magnetization-prepared rapid gradient echo MRIs. Hierarchical regression was used to predict learning and memory with brain atrophy, intellectual enrichment, and the interaction between brain atrophy and intellectual enrichment.
  
  
  RESULTS
  Brain atrophy predicted worse learning and memory, and intellectual enrichment predicted better learning; however, these effects were moderated by interactions between brain atrophy and intellectual enrichment. Specifically, higher intellectual enrichment lessened the negative impact of brain atrophy on both learning and memory.
  
  
  CONCLUSIONS
  These findings help to explain the incomplete relationship between multiple sclerosis disease severity and cognition, as the effect of disease on cognition is attenuated among patients with higher intellectual enrichment. As such, intellectual enrichment is supported as a protective factor against disease-related cognitive impairment in persons with multiple sclerosis.
authors.affiliation: Neuropsychology & Neuroscience Laboratory, Kessler Foundation Research Center, Suite 10, West Orange, NJ 07052, USA. jsumowski@kesslerfoundation.org
authors.forename: James F
authors.initials: JF
authors.lastname: Sumowski
authors.forename: Glenn R
authors.initials: GR
authors.lastname: Wylie
authors.forename: Nancy
authors.initials: N
authors.lastname: Chiaravalloti
authors.forename: John
authors.initials: J
authors.lastname: DeLuca
mesh_terms: D000328:Adult; D001284:Atrophy / Q000473:pathology / Q000523:psychology; D001921:Brain / Q000473:pathology*; D003072:Cognition Disorders / Q000473:pathology / Q000517:prevention & control / Q000523:psychology; D005260:Female; D006801:Humans; D007360:Intelligence; D007361:Intelligence Tests; D007858:Learning / Q000502:physiology; D008297:Male; D008568:Memory / Q000502:physiology; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000473:pathology* / Q000523:psychology*; D009483:Neuropsychological Tests; D014706:Verbal Learning / Q000502:physiology