{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T06:48:51Z","timestamp":1772261331496,"version":"3.50.1"},"reference-count":34,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2015,5,6]],"date-time":"2015-05-06T00:00:00Z","timestamp":1430870400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Mult Scler"],"published-print":{"date-parts":[[2015,9]]},"abstract":"<jats:sec><jats:title>Background:<\/jats:title><jats:p> Recent data suggest that cognitive reserve modulates the adverse effects of multiple sclerosis (MS) pathology on cognitive functioning; however, the protective effects of education in MS are still unclear. <\/jats:p><\/jats:sec><jats:sec><jats:title>Objective:<\/jats:title><jats:p> To explore education as an indicator of cognitive reserve, while controlling for demographic, clinical and genetic features. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods:<\/jats:title><jats:p> A total of 419 MS patients and 159 healthy comparison (HC) subjects underwent a comprehensive neuropsychological (NP) assessment, and answered the Hospital Anxiety and Depression Scale. Based on the HC data, MS patients\u2019 NP scores were adjusted for sex, age and education; and the estimated 5<jats:sup>th<\/jats:sup> percentile (or 95<jats:sup>th<\/jats:sup> percentile, when appropriate) was used to identify any deficits. Patients also performed the Mini-Mental State Examination (MMSE); and their human leucocyte antigen HLA-DRB1 and apolipoprotein E ( ApoE) genotypes were investigated. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p> Patients with higher education were less likely ( p &lt; 0.05) to have cognitive deficits than those with lower education, even when controlling for other covariates. Other significant predictors of cognitive deficit were: age, Expanded Disability Status Scale (EDSS), Multiple Sclerosis Severity Scale (MSSS), and a progressive course. No significant association was found with the HLA-DRB1*15:01 or ApoE \u03b54 alleles. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions:<\/jats:title><jats:p> These results provide support to the use of education as a proxy of cognitive reserve in MS and stress the need to take into account education when approaching cognition in MS. <\/jats:p><\/jats:sec>","DOI":"10.1177\/1352458515581874","type":"journal-article","created":{"date-parts":[[2015,5,7]],"date-time":"2015-05-07T01:56:02Z","timestamp":1430963762000},"page":"1312-1321","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":71,"title":["Cognitive reserve in multiple sclerosis: Protective effects of education"],"prefix":"10.1177","volume":"21","author":[{"given":"Ana","family":"Martins Da Silva","sequence":"first","affiliation":[{"name":"Neurology Service, Hospital de Santo Ant\u00f3nio, Porto, Portugal\/Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Institute of Biomedical Sciences, University of Porto \u2013 UMIB\/ICBAS\/UP"}]},{"given":"Sara","family":"Cavaco","sequence":"additional","affiliation":[{"name":"Neurology Service, Hospital de Santo Ant\u00f3nio, Porto, Portugal\/Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Institute of Biomedical Sciences, University of Porto \u2013 UMIB\/ICBAS\/UP"}]},{"given":"In\u00eas","family":"Moreira","sequence":"additional","affiliation":[{"name":"Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Institute of Biomedical Sciences, University of Porto \u2013 UMIB\/ICBAS\/UP"}]},{"given":"Andreia","family":"Bettencourt","sequence":"additional","affiliation":[{"name":"Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Institute of Biomedical Sciences, University of Porto \u2013 UMIB\/ICBAS\/UP"}]},{"given":"Ernestina","family":"Santos","sequence":"additional","affiliation":[{"name":"Neurology Service, Hospital de Santo Ant\u00f3nio, Porto, Portugal\/Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Institute of Biomedical Sciences, University of Porto \u2013 UMIB\/ICBAS\/UP"}]},{"given":"Cl\u00e1udia","family":"Pinto","sequence":"additional","affiliation":[{"name":"Neurology Service, Hospital de Santo Ant\u00f3nio, Porto, Portugal\/Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Institute of Biomedical Sciences, University of Porto \u2013 UMIB\/ICBAS\/UP"}]},{"given":"Alexandra","family":"Gon\u00e7alves","sequence":"additional","affiliation":[{"name":"Neurology Service, Hospital de Santo Ant\u00f3nio, Porto, Portugal\/Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Institute of Biomedical Sciences, University of Porto \u2013 UMIB\/ICBAS\/UP\/Faculty of Medicine, University of Porto, Portugal"}]},{"given":"Ester","family":"Coutinho","sequence":"additional","affiliation":[{"name":"Neurology Service, Hospital de Santo Ant\u00f3nio, Porto, Portugal"}]},{"given":"Raquel","family":"Sam\u00f5es","sequence":"additional","affiliation":[{"name":"Neurology Service, Hospital de Santo Ant\u00f3nio, Porto, Portugal"}]},{"given":"Cl\u00e1udia C","family":"Dias","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Porto, Portugal\/CINTESIS - Centre for Research in Health Informatics Systems and Technologies, Porto, Portugal"}]},{"given":"Armando","family":"Teixeira-Pinto","sequence":"additional","affiliation":[{"name":"CINTESIS - Centre for Research in Health Informatics Systems and Technologies, Porto, Portugal\/Sydney School of Public Health, University of Sydney, Australia"}]},{"given":"Berta Martins","family":"Da Silva","sequence":"additional","affiliation":[{"name":"Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Institute of Biomedical Sciences, University of Porto \u2013 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