{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T17:09:59Z","timestamp":1775840999080,"version":"3.50.1"},"reference-count":19,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2024,8,5]],"date-time":"2024-08-05T00:00:00Z","timestamp":1722816000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health","award":["01"],"award-info":[{"award-number":["01"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: High cognitive reserve (CR) has been shown to have beneficial effects on global cognition, cognitive decline, and risk of dementia in Parkinson\u2019s disease (PD). We evaluated the influence of CR on the long-term cognitive outcomes of patients with PD who underwent subthalamic nucleus deep brain stimulation (STN-DBS). Methods: Twenty-five patients with PD underwent neuropsychological screening using the Montreal Cognitive Assessment (MoCA) at baseline, 1 year, and 5 years after bilateral STN-DBS. CR was assessed using the Cognitive Reserve Index questionnaire. According to CR score, patients were assigned to two different groups (LowCR group \u2264 130, HighCR group &gt; 130). Results: Our data showed that patients in the HighCR group obtained a better performance with the MoCA total score at long-term follow-up compared to those in the LowCR group ([mean \u00b1 SE] LowCR group: 21.4 \u00b1 1.2 vs. HighCR group: 24.5 \u00b1 1.3, p = 0.05). The cognitive profile of the HighCR group remained unchanged over time. Conversely, the LowCR group had worse global cognition 5 years after surgery (T0: 25.3 \u00b1 0.6 vs. T2: 21.4 \u00b1 1.2, p = 0.02). Cognitive decline was not associated with mood, demographics, or clinical variables. Conclusions: These preliminary findings suggest that higher CR may be protective in PD cognition after STN-DBS. Specifically, a high CR may help cope with long-term decline in the context of surgical treatment. Quantifying a patient\u2019s CR could lead to more personalized medical care, tailoring postoperative support and monitoring for those at higher risk of cognitive decline.<\/jats:p>","DOI":"10.3390\/jcm13154578","type":"journal-article","created":{"date-parts":[[2024,8,5]],"date-time":"2024-08-05T15:45:22Z","timestamp":1722872722000},"page":"4578","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["The Protective Role of Cognitive Reserve: A Preliminary Study on Parkinsonian Patients Undergoing Deep Brain Stimulation"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0935-8645","authenticated-orcid":false,"given":"Eleonora","family":"Zirone","sequence":"first","affiliation":[{"name":"Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0471-4476","authenticated-orcid":false,"given":"Fabiana","family":"Ruggiero","sequence":"additional","affiliation":[{"name":"Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5691-5267","authenticated-orcid":false,"given":"Maria Takeko","family":"Molisso","sequence":"additional","affiliation":[{"name":"Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5109-9483","authenticated-orcid":false,"given":"Roberta","family":"Ferrucci","sequence":"additional","affiliation":[{"name":"Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"},{"name":"Department of Oncology and Haemato-Oncology, University of Milan, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angelica","family":"De Sandi","sequence":"additional","affiliation":[{"name":"Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angelica","family":"Marfoli","sequence":"additional","affiliation":[{"name":"Department of Oncology and Haemato-Oncology, University of Milan, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Denise","family":"Mellace","sequence":"additional","affiliation":[{"name":"Department of Oncology and Haemato-Oncology, University of Milan, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Filippo","family":"Cogiamanian","sequence":"additional","affiliation":[{"name":"Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda","family":"Borellini","sequence":"additional","affiliation":[{"name":"Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enrico","family":"Mailland","sequence":"additional","affiliation":[{"name":"Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Pirola","sequence":"additional","affiliation":[{"name":"Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonella","family":"Ampollini","sequence":"additional","affiliation":[{"name":"Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Locatelli","sequence":"additional","affiliation":[{"name":"Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"},{"name":"Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sergio","family":"Barbieri","sequence":"additional","affiliation":[{"name":"Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4774-582X","authenticated-orcid":false,"given":"Francesca","family":"Mameli","sequence":"additional","affiliation":[{"name":"Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1093\/arclin\/acab049","article-title":"How Can Cognitive Reserve Promote Cognitive and Neurobehavioral Health?","volume":"36","author":"Stern","year":"2021","journal-title":"Arch. Clin. Neuropsychol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1007\/BF03654795","article-title":"Cognitive Reserve Index questionnaire (CRIq): A new instrument for measuring cognitive reserve","volume":"24","author":"Nucci","year":"2012","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1007\/s10072-017-3154-8","article-title":"Cognitive and behavioral disorders in Parkinson\u2019s disease: An update. I: Cognitive impairments","volume":"39","author":"Papagno","year":"2018","journal-title":"Neurol. Sci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1007\/s00702-012-0916-6","article-title":"The influence of cognitive reserve on cognition in Parkinson\u2019s disease","volume":"120","author":"Koerts","year":"2013","journal-title":"J. Neural Transm."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.parkreldis.2013.08.010","article-title":"Cognitive reserve in Parkinson\u2019s disease: A systematic review and meta-analysis","volume":"20","author":"Hindle","year":"2014","journal-title":"Park. Relat. Disord."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1007\/s40520-017-0838-0","article-title":"The role of cognitive reserve in cognitive aging: What we can learn from Parkinson\u2019s disease","volume":"30","author":"Ciccarelli","year":"2018","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.exger.2018.11.020","article-title":"The association of cognitive reserve with motor and cognitive functions for different stages of Parkinson\u2019s disease","volume":"115","author":"Guzzetti","year":"2019","journal-title":"Exp. Gerontol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"83","DOI":"10.14802\/jmd.15010","article-title":"Nonmotor Symptoms and Subthalamic Deep Brain Stimulation in Parkinson\u2019s Disease","volume":"8","author":"Kim","year":"2015","journal-title":"J. Mov. Disord."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1002\/1531-8257(199907)14:4<572::AID-MDS1005>3.0.CO;2-C","article-title":"Core assessment program for surgical interventional therapies in Parkinson\u2019s disease (CAPSITPD)","volume":"14","author":"Defer","year":"1999","journal-title":"Mov. Disord."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1007\/s11065-022-09540-9","article-title":"Deep Brain Stimulation in Parkinson Disease: A Meta-analysis of the Long-term Neuropsychological Outcomes","volume":"33","author":"Bucur","year":"2023","journal-title":"Neuropsychol. Rev."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Mulders, A.E.P., Temel, Y., Tonge, M., Schaper, F.L.W.V., van Kranen-Mastenbroek, V., Ackermans, L., Kubben, P., Janssen, M.L.F., and Duits, A. (2021). The association between surgical characteristics and cognitive decline following deep brain stimulation of the subthalamic nucleus in Parkinson\u2019s disease. Clin. Neurol. Neurosurg., 200.","DOI":"10.1016\/j.clineuro.2020.106341"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.jns.2017.08.3241","article-title":"Educational attainment and motor burden in advanced Parkinson\u2019s disease\u2014The emerging role of education in motor reserve","volume":"381","author":"Blume","year":"2017","journal-title":"J. Neurol. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.parkreldis.2019.10.005","article-title":"Education level affects dual-task gait after deep brain stimulation in Parkinson\u2019s disease","volume":"68","author":"Wegrzyk","year":"2019","journal-title":"Park. Relat. Disord."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Levi, V., Carrabba, G., Rampini, P., and Locatelli, M. (2015). Short term surgical complications after subthalamic deep brain stimulation for Parkinson\u2019s disease: Does old age matter?. BMC Geriatr., 15.","DOI":"10.1186\/s12877-015-0112-2"},{"key":"ref_15","unstructured":"Kaufman, D.M., Geyer, H.L., Milstein, M.J., and Rosengard, J. (2022). Kaufman\u2019s Clinical Neurology for Psychiatrists, Elsevier Health Sciences. [9th ed.]."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1007\/s10072-014-1995-y","article-title":"Normative data for the Montreal Cognitive Assessment in an Italian population sample","volume":"36","author":"Santangelo","year":"2015","journal-title":"Neurol. Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.1007\/s10072-023-06619-w","article-title":"Psychometrics and diagnostics of the Italian version of the Beck Depression Inventory-II (BDI-II) in Parkinson\u2019s disease","volume":"44","author":"Maggi","year":"2023","journal-title":"Neurol. Sci."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1002\/gps.4284","article-title":"The effects of cognitive reserve and lifestyle on cognition and dementia in Parkinson\u2019s disease\u2014A longitudinal cohort study","volume":"31","author":"Hindle","year":"2016","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1080\/13825585.2021.1892026","article-title":"Cognitive reserve: A multidimensional protective factor in Parkinson\u2019s disease related cognitive impairment","volume":"29","author":"Ciccarelli","year":"2022","journal-title":"Neuropsychol. Dev. Cogn. B Aging Neuropsychol. Cogn."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/15\/4578\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:30:25Z","timestamp":1760110225000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/15\/4578"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,5]]},"references-count":19,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["jcm13154578"],"URL":"https:\/\/doi.org\/10.3390\/jcm13154578","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,5]]}}}