Cognitive reserve moderates long-term cognitive and functional outcome in cerebral small vessel disease

Hanna Jokinen, Susanna Melkas, Sofia Madureira, Ana Verdelho, José M Ferro, Franz Fazekas, Reinhold Schmidt, Philip Scheltens, Frederik Barkhof, Joanna M Wardlaw, Domenico Inzitari, Leonardo Pantoni, Timo Erkinjuntti

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: Cerebral small vessel disease (SVD) is characterised by progressive white matter hyperintensities (WMH), cognitive decline and loss of functional independence. The correspondence between neuroimaging findings and the severity of clinical symptoms has been modest, however, and thus the outcome may be affected by various host factors. We investigated the predictive value of educational and occupational attainments as proxy measures of cognitive reserve on long-term cognitive and functional outcome in patients with different degrees of WMH.

METHODS: In the Leukoaraiosis and Disability (LADIS) study, 615 older individuals with WMH were evaluated with brain MRI and detailed clinical and neuropsychological assessments at 3-year follow-up. A prolonged follow-up of functional and cognitive status was administered with a structured telephone interview after up to 7 years.

RESULTS: Higher levels of educational and occupational attainment were strongly related to baseline cognitive scores and predicted a slower rate of decline at 3-year follow-up in measures of processing speed, executive functions and memory independently of WMH volume and other confounders. The deleterious effect of WMH on processing speed and memory was moderated by education and occupation. Education mitigated the relation of WMH volume on 7-year cognitive status. Moreover, higher education and occupational attainments were related to favourable outcome at 7-year follow-up as defined by sustained functional independence and lower mortality.

CONCLUSIONS: The results support the presumption that cognitive reserve plays a significant role as a buffer against the clinical manifestations of SVD and may in part explain high individual variability in outcome.

Original languageEnglish
Pages (from-to)1296-1302
Number of pages7
JournalJournal of Neurology, Neurosurgery and Psychiatry
Volume87
Issue number12
DOIs
Publication statusPublished - Dec 2016

Cite this

Jokinen, H., Melkas, S., Madureira, S., Verdelho, A., Ferro, J. M., Fazekas, F., ... Erkinjuntti, T. (2016). Cognitive reserve moderates long-term cognitive and functional outcome in cerebral small vessel disease. Journal of Neurology, Neurosurgery and Psychiatry, 87(12), 1296-1302. https://doi.org/10.1136/jnnp-2016-313914
Jokinen, Hanna ; Melkas, Susanna ; Madureira, Sofia ; Verdelho, Ana ; Ferro, José M ; Fazekas, Franz ; Schmidt, Reinhold ; Scheltens, Philip ; Barkhof, Frederik ; Wardlaw, Joanna M ; Inzitari, Domenico ; Pantoni, Leonardo ; Erkinjuntti, Timo. / Cognitive reserve moderates long-term cognitive and functional outcome in cerebral small vessel disease. In: Journal of Neurology, Neurosurgery and Psychiatry. 2016 ; Vol. 87, No. 12. pp. 1296-1302.
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title = "Cognitive reserve moderates long-term cognitive and functional outcome in cerebral small vessel disease",
abstract = "BACKGROUND: Cerebral small vessel disease (SVD) is characterised by progressive white matter hyperintensities (WMH), cognitive decline and loss of functional independence. The correspondence between neuroimaging findings and the severity of clinical symptoms has been modest, however, and thus the outcome may be affected by various host factors. We investigated the predictive value of educational and occupational attainments as proxy measures of cognitive reserve on long-term cognitive and functional outcome in patients with different degrees of WMH.METHODS: In the Leukoaraiosis and Disability (LADIS) study, 615 older individuals with WMH were evaluated with brain MRI and detailed clinical and neuropsychological assessments at 3-year follow-up. A prolonged follow-up of functional and cognitive status was administered with a structured telephone interview after up to 7 years.RESULTS: Higher levels of educational and occupational attainment were strongly related to baseline cognitive scores and predicted a slower rate of decline at 3-year follow-up in measures of processing speed, executive functions and memory independently of WMH volume and other confounders. The deleterious effect of WMH on processing speed and memory was moderated by education and occupation. Education mitigated the relation of WMH volume on 7-year cognitive status. Moreover, higher education and occupational attainments were related to favourable outcome at 7-year follow-up as defined by sustained functional independence and lower mortality.CONCLUSIONS: The results support the presumption that cognitive reserve plays a significant role as a buffer against the clinical manifestations of SVD and may in part explain high individual variability in outcome.",
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Jokinen, H, Melkas, S, Madureira, S, Verdelho, A, Ferro, JM, Fazekas, F, Schmidt, R, Scheltens, P, Barkhof, F, Wardlaw, JM, Inzitari, D, Pantoni, L & Erkinjuntti, T 2016, 'Cognitive reserve moderates long-term cognitive and functional outcome in cerebral small vessel disease' Journal of Neurology, Neurosurgery and Psychiatry, vol. 87, no. 12, pp. 1296-1302. https://doi.org/10.1136/jnnp-2016-313914

Cognitive reserve moderates long-term cognitive and functional outcome in cerebral small vessel disease. / Jokinen, Hanna; Melkas, Susanna; Madureira, Sofia; Verdelho, Ana; Ferro, José M; Fazekas, Franz; Schmidt, Reinhold; Scheltens, Philip; Barkhof, Frederik; Wardlaw, Joanna M; Inzitari, Domenico; Pantoni, Leonardo; Erkinjuntti, Timo.

In: Journal of Neurology, Neurosurgery and Psychiatry, Vol. 87, No. 12, 12.2016, p. 1296-1302.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Cognitive reserve moderates long-term cognitive and functional outcome in cerebral small vessel disease

AU - Jokinen, Hanna

AU - Melkas, Susanna

AU - Madureira, Sofia

AU - Verdelho, Ana

AU - Ferro, José M

AU - Fazekas, Franz

AU - Schmidt, Reinhold

AU - Scheltens, Philip

AU - Barkhof, Frederik

AU - Wardlaw, Joanna M

AU - Inzitari, Domenico

AU - Pantoni, Leonardo

AU - Erkinjuntti, Timo

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

PY - 2016/12

Y1 - 2016/12

N2 - BACKGROUND: Cerebral small vessel disease (SVD) is characterised by progressive white matter hyperintensities (WMH), cognitive decline and loss of functional independence. The correspondence between neuroimaging findings and the severity of clinical symptoms has been modest, however, and thus the outcome may be affected by various host factors. We investigated the predictive value of educational and occupational attainments as proxy measures of cognitive reserve on long-term cognitive and functional outcome in patients with different degrees of WMH.METHODS: In the Leukoaraiosis and Disability (LADIS) study, 615 older individuals with WMH were evaluated with brain MRI and detailed clinical and neuropsychological assessments at 3-year follow-up. A prolonged follow-up of functional and cognitive status was administered with a structured telephone interview after up to 7 years.RESULTS: Higher levels of educational and occupational attainment were strongly related to baseline cognitive scores and predicted a slower rate of decline at 3-year follow-up in measures of processing speed, executive functions and memory independently of WMH volume and other confounders. The deleterious effect of WMH on processing speed and memory was moderated by education and occupation. Education mitigated the relation of WMH volume on 7-year cognitive status. Moreover, higher education and occupational attainments were related to favourable outcome at 7-year follow-up as defined by sustained functional independence and lower mortality.CONCLUSIONS: The results support the presumption that cognitive reserve plays a significant role as a buffer against the clinical manifestations of SVD and may in part explain high individual variability in outcome.

AB - BACKGROUND: Cerebral small vessel disease (SVD) is characterised by progressive white matter hyperintensities (WMH), cognitive decline and loss of functional independence. The correspondence between neuroimaging findings and the severity of clinical symptoms has been modest, however, and thus the outcome may be affected by various host factors. We investigated the predictive value of educational and occupational attainments as proxy measures of cognitive reserve on long-term cognitive and functional outcome in patients with different degrees of WMH.METHODS: In the Leukoaraiosis and Disability (LADIS) study, 615 older individuals with WMH were evaluated with brain MRI and detailed clinical and neuropsychological assessments at 3-year follow-up. A prolonged follow-up of functional and cognitive status was administered with a structured telephone interview after up to 7 years.RESULTS: Higher levels of educational and occupational attainment were strongly related to baseline cognitive scores and predicted a slower rate of decline at 3-year follow-up in measures of processing speed, executive functions and memory independently of WMH volume and other confounders. The deleterious effect of WMH on processing speed and memory was moderated by education and occupation. Education mitigated the relation of WMH volume on 7-year cognitive status. Moreover, higher education and occupational attainments were related to favourable outcome at 7-year follow-up as defined by sustained functional independence and lower mortality.CONCLUSIONS: The results support the presumption that cognitive reserve plays a significant role as a buffer against the clinical manifestations of SVD and may in part explain high individual variability in outcome.

U2 - 10.1136/jnnp-2016-313914

DO - 10.1136/jnnp-2016-313914

M3 - Article

VL - 87

SP - 1296

EP - 1302

JO - Journal of Neurology, Neurosurgery and Psychiatry

JF - Journal of Neurology, Neurosurgery and Psychiatry

SN - 0022-3050

IS - 12

ER -