Abstract

Objective: Long-term life experiences, such as education, occupational attainment, leisure activities, and bilingualism, have been considered proxies of cognitive reserve (CR). In neurodegenerative disease, CR is considered as a modulator of a more favorable cognitive trajectory and motor functions. Our study investigated the role of CR on cognitive and motor involvement in a large cohort of incident patients with amyotrophic lateral sclerosis (ALS). Methods: Cognition assessment and clinical and demographic information were obtained in 101 incident ALS patients. CR was measured based on years of education, occupational attainment, amount of leisure activities, and bilingualism. Correlation and regression analyses were performed to test the association between CR and the clinical expression of ALS. Results: We found that all proxies of CR were positively associated with executive functions, verbal fluency, and memory domains. Motor impairment was inversely related to educational level and occupational attainment. Regression analysis documented the association between CR and cognitive performances in all patients and the predictive role of CR in modulating motor functional disability in patients with bulbar-onset. Conclusion: Our findings showed that CR mediates the extent of cognitive decline and that of functional bulbar impairment, suggesting that the concept of reserve applied to ALS should encompass cognitive and motor domains.

摘要

目标：长期生活经历，如教育、职业成就、休闲活动和双语能力，被认为是认知储备 (CR) 的代表。在神经退行性疾病中，CR 被认为是更有利的认知轨迹和运动功能的调节剂。我们的研究调查了 CR 在一大群肌萎缩侧索硬化 (ALS) 患者中认知和运动受累的作用。方法：在 101 名 ALS 患者中获得了认知评估以及临床和人口统计学信息。CR 是根据受教育年限、职业成就、休闲活动量和双语能力来衡量的。进行相关性和回归分析以测试 CR 与 ALS 临床表现之间的关联。结果：我们发现 CR 的所有代理都与执行功能、语言流畅性和记忆域呈正相关。运动障碍与教育水平和职业成就呈负相关。回归分析记录了所有患者的 CR 与认知能力之间的关联，以及 CR 在调节延髓起病患者运动功能障碍中的预测作用。结论：我们的研究结果表明，CR 介导认知能力下降的程度和功能性延髓损伤的程度，这表明应用于 ALS 的储备概念应包括认知和运动领域。