Education level may protect against cognitive decline in MS

Patients with multiple sclerosis (MS) who had a higher level of education had less cognitive impairment related to their disease than patients with a lower level of education, the investigators concluded.

School results may provide a protective effect against cognitive dysfunction associated with multiple sclerosis (MS), researchers found in a study Posted in International Neurology.

The descriptive cross-sectional study also showed that patients with a university degree, undergraduate degree and / or doctorate (higher education) retained better verbal ability than patients who had completed only primary education.

“Our study shows that education level is a potentially protective factor against disease, acting as a source of intellectual enrichment that provides cognitive reserve in MS patients, thereby helping to alleviate cognitive decline,” wrote the investigators.

About 80% of people with MS develop cognitive deficits, especially in attention, memory, information processing, and executive functions, all of which can affect patients’ quality of life. Memory dysfunction is one of the earliest symptoms of MS, and research has shown that verbal fluency is affected in 40% to 64% of MS patients.

Although recent studies have shown that intellectual enrichment can alleviate cognitive decline in MS, researchers wanted to assess how socio-demographic variables, such as age, level of education, gender, and type of MS , influence the progression of the disease. The present study focused on 2 subtypes of MS: relapsing-remitting MS (RRMS) and secondary progressive MS (SPMS).

The investigators included 65 patients with MS, of whom 49 had RRMS and 16 had MS. The patients were recruited from the multiple sclerosis patient population of the University Hospital of León in Spain. Patient demographic information was collected during an interview and cognitive decline was assessed using a neuropsychological assessment instrument.

The vast majority of patients with RRMS were female (n = 41; 83.7%) and were 40 years of age or younger (n = 30; 61.2%). When divided by level of education, 30.6% of the cohort had primary education (6 to 8 years of formal education), 42.9% had secondary education (8 to 12 years of formal education ) and 26.5% had higher education (15 years or more of formal education).

Of the patients with PMSC, 56.2% (n = 9) were female and 68.7% (n = 11) were 40 years of age or older. By education level, 12.5% ​​of patients had primary education, 56.2% had secondary education and 31.3% had higher education.

Multivariate analyzes showed that patients with a higher level of education had statistically significantly better verbal fluency (P

Additionally, a nonparametric analysis found that compared to primary education levels, higher education levels were associated with higher logical memory scores (29.71 vs. 34.67) and fluency tests. verbal (21.02 versus 38.97).

Investigators found that gender was associated with short-term memory, which was statistically significantly impacted in women more than in men (35.74 vs. 25.26; P <.005 age and type of ms have not been associated with cognitive variables. the level disability was found to be statistically significantly related differences in logical memory verbal fluency during multivariate logistic regression analysis.>

The small sample size and the cross-sectional design of the study were listed as limitations of the study. In addition, the interviews with the participants did not include questions on the duration of their illness.

“We believe it would be useful to conduct a long-term longitudinal study in which newly diagnosed participants were grouped by education level and time from onset to determine whether these associations and correlations remain significant in terms of relates to the long-term prognosis and this a putative protective effect, ”the investigators said.


Estrada-López M, García-Martín S, Cantón-Mayo I. Cognitive dysfunction in multiple sclerosis: level of education as a protective factor. Neurol Int. 2021; 13 (3): 335-342. doi: 10.3390 / neurolint13030034