How cognitive reserve keeps your brain flexible

Wed 02 October 2024

Clara Stein

Clara Stein is a PhD student at University College Dublin. She won our writing competition for researchers with this article about her work. She tells us how using our brain can help it adapt to MS.

Do you read books, socialise with friends or clean your home? Maybe you exercise, work or play a musical instrument? If so, congratulations! You’re helping your brain to adapt to MS. 

Brain changes and cognitive difficulties 

MS can lead to changes in the brain, which may be associated with cognitive difficulty. Around six in ten people with MS experience some level of cognitive difficulty. This might be difficulty with thinking quickly, following a conversation, or remembering a shopping list. 

However, brain changes alone can’t fully explain why some people with MS experience more cognitive difficulty than others. Two people with similar MS brain changes don’t necessarily experience the same level of cognitive difficulty. It seems as though some people with MS may have a more flexible brain that's able to adapt better to brain changes. This may be partly due to something called 'cognitive reserve'. 

What's cognitive reserve?

Cognitive reserve describes your brain's ability to adapt to changes. Someone with greater cognitive reserve may experience less cognitive difficulty due to brain changes.

We currently can’t measure cognitive reserve directly. Instead, researchers try to estimate it through your experiences in education and work. And whether you do certain activities for leisure which require focus.

What does it mean to have a flexible brain with cognitive reserve?

Imagine that to follow a conversation, your brain uses a complex network. Think of this network as similar to the streets of a busy city. You may be used to driving home from school or work using street A. But today, the street is blocked. Fortunately, you know that there are other ways to get home. It might take a bit longer, but you’ll get there safely. 

By engaging in enriching everyday activities, we may be able to help our brains be more flexible. 

Taking part in any focused, complex activities can train our brains in thinking of alternative routes. These activities could be education, work, exercising, socialising, reading or playing a musical instrument. There’s evidence to show people with MS who engage more frequently in these enriching activities have less cognitive difficulty.

This doesn’t mean cognitive reserve can always protect you. Using the same analogy, if most roads in your city are blocked, it can still be tricky to get home. But the more alternative routes you know, the higher the chances are that you’ll find a way. 

Road to the future

I think the idea of cognitive reserve is really good news. It means a lot of the activities we do as part of everyday life also help our brains. But there’s still a lot more we need to learn about how this works in MS. 

At this stage, we know little about how common MS symptoms influence cognitive reserve. Many people with MS experience fatigue, depression and anxiety. Experiencing any of these so-called invisible symptoms may impact a person’s ability to do enriching activities. Unfortunately, invisible symptoms are still often overlooked, both in clinical practice and in research.

At the moment, we’re trying to address this gap in our research. Instead of just collecting data on cognitive reserve and cognitive outcomes, we’re also asking participants about their experience of invisible symptoms. And self-reported cognitive difficulty. 

Our goal is to gain a better understanding of how cognitive reserve is developed in MS. And how we might use this knowledge to achieve a better quality of life and care for people with MS.