Preserved Cognition With Multiple Sclerosis at Age 60: Association With Sex-specific Lifespan Factors
Denisse Morales-Rodriguez1, Hannah Silverman1, Maria Pia Campagna1, Alyssa Nylander1, Amit Akula1, Refujia Gomez1, Adam Santaniello1, Adam Renschen1, Meagan Harms1, Tiffany Cooper1, Robin Lincoln1, Shane Poole1, Roland Henry1, Stephen Hauser1, Bruce Cree1, Riley Bove1
1UCSF Weill Institute for Neurosciences
Objective:
Identify predictors of preserved cognition in older adults with MS.
Background:
Cognition declines with age and over the multiple sclerosis (MS) disease course, yet the predictors of preserved cognition in older people with MS are underexplored. Lifespan exposures, such as neighborhood income and reproductive factors, may contribute to cognition in this patient population.
Design/Methods:
Prospectively collected cognitive measures were evaluated at age 60 for 182 adults with MS participating in a longitudinal cohort study. Cognition was assessed and normalized using two cognitive tests (Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test-3 (PASAT-3)). Linear regression models were fit for clinical and sociodemographic variables for the entire cohort as well as for males and females separately. Covariates were: disease duration, presence of comorbidities, BMI, Expanded Disability Status Scale (EDSS) score, median home value in zip code, and for the female-specific model: reproductive lifespan (age menopause – age menarche).
Results:
In this cohort, 13% had preserved cognition by both SDMT and PASAT-3. In the entire cohort, disease duration, presence of comorbidities, and EDSS scores were significantly associated with cognition. In males only, higher cognitive scores were associated with higher median neighborhood home value (PASAT-3: beta=0.0168, p=0.011) and in females only, with a reproductive lifespan greater than 30 years (PASAT-3: beta=0.4761, p=0.042; SDMT: beta=0.528, p=0.036). In a sensitivity analysis using data from a subset of the cohort, T2 lesion volume was associated with worse cognition (PASAT-3: beta=-1.346, p=0.006; SDMT: beta=-3.759, p=0.001).
Conclusions:
Cognition at older ages showed sex-specific associations with neighborhood enrichment and lifetime reproductive factors. A holistic lifespan approach to understanding cognitive resilience could ultimately inform prevention and rehabilitation approaches to cognitive function in people with MS.
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