title: Cognitive reserve and patient-reported outcomes in multiple sclerosis.
abstract: BACKGROUND
  Adaptation and compensation in the face of changing pathology may be better understood by considering the concept of cognitive reserve, which may protect against disability in multiple sclerosis (MS).
  
  
  OBJECTIVE
  The present work investigates the relationship between cognitive reserve and demographic characteristics, health behaviors, and patient-reported outcomes (PROs).
  
  
  METHODS
  Cross-sectional data (n=1142) were drawn from the North American Research Committee on MS (NARCOMS) Registry, from whom additional survey data were collected. Cognitive reserve was measured using the Stern and Sole-Padulles measures, the O*NET occupational classification system, and the Godin Leisure-Time Exercise Questionnaire. PROs were assessed using generic (SF -12v2, Perceived Deficits Questionnaire, Ryff Psychological Well-Being, Diener Satisfaction with Life Scale) and disease-specific (Patient-Determined Disease Steps, Performance Scales) measures. Psychometric analysis created unidimensional cognitive reserve subscales. Regression models examined relationships between cognitive reserve, demographic characteristics, and PROs.
  
  
  RESULTS
  The cognitive reserve measures assessed distinct but related constructs. Individuals with high cognitive reserve were more likely to report lower levels of perceived disability and perceived cognitive deficits, and higher levels of physical health, mental health, and well-being. Both active and passive reserve are associated with better outcomes, independent of demographic factors, and these associations apply to both generic and disease-specific outcomes.
  
  
  CONCLUSIONS
  This expanded measurement of cognitive reserve captures both the passive and active aspects of the construct, and there is a consistent and substantial relationship with PROs. Individuals with high passive and/or active reserve are healthier and experience higher levels of well-being.
authors.affiliation: DeltaQuest Foundation, Inc., Concord, USA. carolyn.schwartz@deltaquest.org
authors.forename: Carolyn E
authors.initials: CE
authors.lastname: Schwartz
authors.forename: Erin
authors.initials: E
authors.lastname: Snook
authors.forename: Brian
authors.initials: B
authors.lastname: Quaranto
authors.forename: Ralph H B
authors.initials: RH
authors.lastname: Benedict
authors.forename: Timothy
authors.initials: T
authors.lastname: Vollmer
mesh_terms: D058245:Cognitive Reserve; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000523:psychology*; D011594:Psychometrics; D011788:Quality of Life; D057566:Self Report; D011795:Surveys and Questionnaires