title: The cognitive reserve theory in the setting of pediatric-onset multiple sclerosis.
abstract: The study of cognitive reserve (CR) in relationship with cognitive impairment (CI) in pediatric-onset multiple sclerosis (POMS) may provide cues to identifying subjects at higher risk of impairment and scope for therapeutic strategies.
  
  
  
  To assess the potential impact of CR on cognition in a cohort of POMS patients.
  
  
  
  In all, 48 POMS patients were followed up for 4.7 ± 0.4 years. CI was defined as the failure of ⩾3 tests on an extensive neuropsychological battery. Change of neuropsychological performance was assessed through the Reliable Change Index (RCI) method. At baseline, CR was estimated by measuring the intelligence quotient (IQ). The relationships were assessed through multivariable regression analyses.
  
  
  
  At baseline, CI was detected in 14/48 (29.2%) patients. Two out of 57 healthy control (HC; 3.5%) met the same criteria of CI (p < 0.001). A deteriorating cognitive performance using the RCI method was observed in 18/48 patients (37.6%). Among the 34 cases who were cognitively preserved at baseline, a higher reserve predicted stable/improving performance (odds ratio (OR) = 1.11; 95% confidence interval (CI): 1.03-1.20; p = 0.006).
  
  
  
  Our results suggest that higher CR in POMS patients may protect from CI, particularly in subjects with initial cognitive preservation, providing relevant implications for counseling and rehabilitation strategies.
authors: Department of NEUROFARBA, University of Florence, Florence, Italy.
authors: Luisa
authors: L
authors: Pastò
authors: Department of NEUROFARBA, University of Florence, Florence, Italy/Don Carlo Gnocchi Foundation, Florence, Italy.
authors: Emilio
authors: E
authors: Portaccio
authors: Department of NEUROFARBA, University of Florence, Florence, Italy.
authors: Benedetta
authors: B
authors: Goretti
authors: MS Center, Hospital of Gallarate, Gallarate, Italy.
authors: Angelo
authors: A
authors: Ghezzi
authors: Department of NEUROFARBA, University of Florence, Florence, Italy.
authors: Silvia
authors: S
authors: Lori
authors: Department of NEUROFARBA, University of Florence, Florence, Italy/Don Carlo Gnocchi Foundation, Florence, Italy.
authors: Bahia
authors: B
authors: Hakiki
authors: Department of NEUROFARBA, University of Florence, Florence, Italy.
authors: Marta
authors: M
authors: Giannini
authors: Department of NEUROFARBA, University of Florence, Florence, Italy.
authors: Isabella
authors: I
authors: Righini
authors: Department of NEUROFARBA, University of Florence, Florence, Italy.
authors: Lorenzo
authors: L
authors: Razzolini
authors: Department of NEUROFARBA, University of Florence, Florence, Italy.
authors: Claudia
authors: C
authors: Niccolai
authors: Department of Neurology, San Raffaele Scientific Institute, Milan, Italy.
authors: Lucia
authors: L
authors: Moiola
authors: Department of Neurology, San Raffaele Scientific Institute, Milan, Italy.
authors: Monica
authors: M
authors: Falautano
authors: Department of Basic Medical Sciences, Neuroscience and sense Organs, University of Bari Aldo Moro, Bari, Italy.
authors: Marta
authors: M
authors: Simone
authors: Department of Basic Medical Sciences, Neuroscience and sense Organs, University of Bari Aldo Moro, Bari, Italy.
authors: Rosa Gemma
authors: RG
authors: Viterbo
authors: Division of Neuroscience, Department of Medical and Surgical Science and Advanced Technologies and Department "GF Ingrassia," Multiple Sclerosis Center, University of Catania, Catania, Italy.
authors: Francesco
authors: F
authors: Patti
authors: Department of Psychology, ASP Trapani, Trapani, Italy.
authors: Sabina
authors: S
authors: Cilia
authors: Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.
authors: Carlo
authors: C
authors: Pozzilli
authors: Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.
authors: Valentina
authors: V
authors: Bianchi
authors: MS Center, Hospital of Gallarate, Gallarate, Italy.
authors: Marco
authors: M
authors: Roscio
authors: Department of Neurology, San Raffaele Scientific Institute, Milan, Italy.
authors: Vittorio
authors: V
authors: Martinelli
authors: Department of Neurology, San Raffaele Scientific Institute, Milan, Italy.
authors: Giancarlo
authors: G
authors: Comi
authors: Department of Basic Medical Sciences, Neuroscience and sense Organs, University of Bari Aldo Moro, Bari, Italy.
authors: Maria
authors: M
authors: Trojano
authors: Department of NEUROFARBA, University of Florence, Florence, Italy mariapia.amato@unifi.it.
authors: Maria Pia
authors: MP
authors: Amato
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D002648:Child; D060825:Cognitive Dysfunction / Q000209:etiology / Q000503:physiopathology*; D058245:Cognitive Reserve / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009103:Multiple Sclerosis / Q000150:complications / Q000503:physiopathology*
keywords: Pediatric-onset multiple sclerosis; cognitive impairment; cognitive reserve; intelligence quotient