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The relationship between biological sex, cognitive reserve, and cognition in multiple sclerosis

Published online by Cambridge University Press:  02 April 2025

Manuela Altieri Open the ORCID record for Manuela Altieri [Opens in a new window] ,
Alvino Bisecco ,
Alessandro d’Ambrosio ,
Valentina Rippa ,
Mario Risi ,
Riccardo Maria Borgo ,
Daniela Buonanno ,
Teresa Cuomo ,
Alessandro Tessitore  and
Gabriella Santangelo Open the ORCID record for Gabriella Santangelo [Opens in a new window]
...Show all authors
Manuela Altieri*
Affiliation:
Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy
Alvino Bisecco
Affiliation:
Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
Alessandro d’Ambrosio
Affiliation:
Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
Valentina Rippa
Affiliation:
Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
Mario Risi
Affiliation:
Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
Riccardo Maria Borgo
Affiliation:
Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
Daniela Buonanno
Affiliation:
Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
Teresa Cuomo
Affiliation:
Department of Neurology, Umberto I Hospital, Nocera Inferiore, Italy
Alessandro Tessitore
Affiliation:
Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
Gabriella Santangelo
Affiliation:
Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy
Antonio Gallo
Affiliation:
Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
*
Corresponding author: Manuela Altieri; Email: [email protected]
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Abstract

Objective:

Cognitive impairment is a common feature of multiple sclerosis (MS), and its severity may be influenced by several factors, such as biological sex and levels of cognitive reserve (CR). The relationship between sex, CR, and cognition has not yet been fully investigated. Therefore, the present study aimed to explore sex differences in CR building and the effect of sex and CR on cognitive performance in MS.

Method:

233 participants underwent the Brief Repeatable Battery of Neuropsychological Tests (BRB-N), the Stroop test, and the Cognitive Reserve Scale. The t-test was performed to compare sociodemographic variables, Italian adaptation of the Cognitive Reserve Scale, and cognitive test scores between sexes. To evaluate the effect of CR and sex and their interaction on cognitive performance several models of multivariate analyses of covariance were performed (dependent variables: all subtests of Brief Repeatable Battery of Neuropsychological Tests and Stroop scores; independent variables: sex and CR). Covariates included age, Expanded Disability Status Scale, and BDI-II scores.

Results:

Women showed higher levels of CR, particularly in daily activities (t = −5.848, p<.001), hobbies (t = −2.591, p = .010), and social life (t = −2.362, p = .011). Sex differences were noted in verbal memory and fluency (with women outperforming men) and processing speed (with men performing better than women). Multivariate analyses revealed a nonsignificant interaction between CR and sex on cognition (Λ=.950, F(10,260)=.813, p = .617, ηp2 = .050).

Conclusions:

CR and sex seemed to affect cognitive performance independently in pwMS. This highlights the importance of considering both factors in cognitive assessment, and that both sexes may benefit from specific psychoeducational training aimed at increasing CR levels.

Keywords

Sexcognitive reservecognitionmultiple sclerosiscognitive performancesex differences
Type
Research Article
Information
Journal of the International Neuropsychological Society , First View , pp. 1 - 9
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of International Neuropsychological Society

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