Cognitive enrichment and education quality moderate cognitive dysfunction in black and white adults with multiple sclerosis

Jeremy G Grant; Lisa J Rapport; Rachel Darling; Brigid Waldron-Perrine; Mark A Lumley; Keith E Whitfield; Evanthia Bernitsas

doi:10.1016/j.msard.2023.104916

Cognitive enrichment and education quality moderate cognitive dysfunction in black and white adults with multiple sclerosis

Mult Scler Relat Disord. 2023 Oct:78:104916. doi: 10.1016/j.msard.2023.104916. Epub 2023 Jul 24.

Authors

Jeremy G Grant¹, Lisa J Rapport², Rachel Darling³, Brigid Waldron-Perrine⁴, Mark A Lumley², Keith E Whitfield⁵, Evanthia Bernitsas³

Affiliations

¹ Department of Psychology, Wayne State University, 5057 Woodward Ave., Detroit, MI 48202, USA. Electronic address: jeremy.grant@wayne.edu.
² Department of Psychology, Wayne State University, 5057 Woodward Ave., Detroit, MI 48202, USA.
³ Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA.
⁴ Department of Physical Medicine & Rehabilitation, Wayne State University School of Medicine, Detroit, MI, USA.
⁵ Department of Psychology and Department of Brain Health, University of Nevada, Las Vegas, NV, USA.

PMID: 37552903
DOI: 10.1016/j.msard.2023.104916

Abstract

Objective: To examine the extent to which three sociobehavioral proxies of cognitive reserve-years of education, education quality, and cognitive enrichment-differ in their prediction of cognitive performance among Black and White people with MS (PwMS).

Methods: 82 PwMS (Black n = 41, White n = 41) underwent a neurological examination and a neuropsychological evaluation that included tests of word recognition (Wechsler Test of Adult Reading) as well as measures of verbal memory, visuospatial memory, and processing speed (the Brief International Cognitive Assessment for MS; BICAMS). Participants rated their lifetime engagement in various cognitively-enriching activities (Cognitive Reserve Scale).

Results: For the full sample, education quality and cognitive enrichment were more strongly associated with cognitive performance than were years of education. Cognitive enrichment was not associated with cognitive performance among participants with high education quality. In contrast, among participants with low education quality, cognitive enrichment was strongly associated with cognitive performance, suggesting that high engagement in cognitively-enriching activities provided similar protection to high education quality. Furthermore, among Black participants, cognitive enrichment and educational quality moderated the relationship between disability level and cognitive performance. In contrast, among White participants, cognitive enrichment did not provide additional protection beyond the buffering effect of education quality.

Conclusions: PwMS can successfully build reserve through multiple routes, including formal education or informal cognitive enrichment. Treatment for MS should incorporate cognitively-enriching activities to build resilience against cognitive decline, particularly for members of marginalized racial/ethnic groups, who are at greatest risk for poor health outcomes, and for whom years of education may not best reflect education quality.

Keywords: Cognitive reserve; Multiple sclerosis; Racial health disparities.