title: Cognitive reserve lessens the burden of white matter lesions on executive functions in bipolar disorder.
abstract: The concept of cognitive reserve (CR) hypothesizes that intellectually stimulating activities provide resilience against brain pathology/disease. Whereas brain abnormalities and cognitive impairment are frequently reported in bipolar disorder (BD), it is unknown whether the impact of brain alterations can be lessened by higher CR in BD.
  
  
  
  We tested if higher CR would reduce the influence of total volumes of deep white matter hypointensities (WMH), ventricular cerebrospinal fluid (CSF), and prefrontal cortex on memory, executive, and attention/speed functions in patients with BD (n = 75). Linear regression models with interaction terms for CR and brain volumes were applied to directly test if CR reduces the influence of brain pathology on cognitive domains.
  
  
  
  CR reduced the influence of total volumes of deep WMH (β = -0.38, Q = 0.003) and ventricular CSF (β = -41, Q = 006) on executive functions.
  
  
  
  The interactions between CR and total volumes of deep WMH/ventricular CSF appear to account for executive functioning in BD. The results suggest that the concept of CR is applicable in BD. Higher reserve capacity in BD alters the relationship between brain pathology and clinical presentation.
authors.affiliation: Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University,Gothenburg,Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Rolstad
authors.affiliation: Department of Clinical Neuroscience,Osher Center, Karolinska Institutet,Stockholm,Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Abé
authors.affiliation: Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University,Gothenburg,Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Olsson
authors.affiliation: Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University,Gothenburg,Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Eckerström
authors.affiliation: Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University,Gothenburg,Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Landén
mesh_terms: D000328:Adult; D001288:Attention / Q000502:physiology; D001714:Bipolar Disorder / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000523:psychology*; D001921:Brain / Q000000981:diagnostic imaging* / Q000473:pathology; D016022:Case-Control Studies; D002555:Cerebrospinal Fluid / Q000000981:diagnostic imaging*; D060825:Cognitive Dysfunction / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000523:psychology*; D058245:Cognitive Reserve; D056344:Executive Function; D005260:Female; D006801:Humans; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008568:Memory / Q000502:physiology; D008875:Middle Aged; D009929:Organ Size; D017397:Prefrontal Cortex / Q000000981:diagnostic imaging* / Q000473:pathology; D011930:Reaction Time; D066127:White Matter / Q000000981:diagnostic imaging* / Q000473:pathology; D055815:Young Adult
keywords: Bipolar disorder; cognition; cognitive reserve; magnetic resonance imaging