Dados do Trabalho

Título

Is cognitive reserve a predictor of the clinical outcome of Amyotrophic Lateral Sclerosis? A longitudinal study.

Resumo

Introduction: Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease with motor neuron involvement and non-motor symptoms, such as cognitive and behavioral deficits. It is unclear whether cognitive reserve has a protective factor in the rate of functional decline in patients with sporadic ALS (sALS).
Objective: To investigate the effect of cognitive reserve on the clinical outcome of sALS patients.
Methods: This longitudinal study included patients with the diagnosis of probable or definite ALS according to Awaji criteria, between March/2018 and March/2020. Patients underwent regular clinical assessments, including the ALS Functional Rating Scale-Revised (ALSFRS-R). Patients were evaluated at the baseline, 6 months, 12 months and 18 months after inclusion. We considered years of education (schooling) as a proxy of cognitive reserve. Correlation and linear regression analysis were performed to test the association between schooling and ALSFRS decline.
Results: We included 55 individuals (31 male) with sALS (mean age=55.3 years, mean schooling =7.16 years and median disease duration = 2.1 years). Eighteen patients died during the follow-up. The mean (±SD, number of patients) for ALSFRS-R scores were, respectively: 31.22 (±10.7, 55), 28.2 (±11, 48), 24.8 (±10,4, 41) and 22.2 (±10.1, 37), at baseline, 6, 12 and 18 months. Multivariate analyses including ALSFRS-R variation, schooling, disease duration, age and spinal/bulbar onset, found that disease duration was positively correlated with ALSFRS-R decline (B=0.73, p<0.05). The other variables did not show association with disease progression.
Conclusion: In this series, schooling was not a predictor of clinical decline in sALS. More studies, with larger samples, are warranted to investigate the influence of cognitive reserve in the clinical outcome of ALS patients.