Education Level May Protect Against Cognitive Decline in MS

Patients with multiple sclerosis (MS) who had a higher education level experienced less cognitive impairment related to their disease than patients with a lower education level, investigators concluded.

Educational achievements may provide a protective effect against cognitive dysfunction associated with multiple sclerosis (MS), investigators concluded in a study published in Neurology International.

The descriptive cross-sectional study also showed that patients with a university diploma, an undergraduate degree, and/or a doctorate (higher education) were found to maintain a better verbal capacity than patients who had only completed primary education.

“Our study shows that educational level is a potentially protective factor against the disease, acting as a source of intellectual enrichment that provides a cognitive reserve for MS patients, so helping to mitigate cognitive decline,” wrote the investigators.

About 80% of people with MS develop cognitive deficits, particularly in attention, memory, information processing, and executive functions, all of which can impair patients’ quality of life. Memory dysfunction is one of the MS symptoms that presents first, and research has shown that verbal fluency is affected in 40% to 64% of patients with MS.

Although recent studies have has shown that intellectual enrichment can mitigate cognitive decline in MS, the investigators wanted to gauge how sociodemographic variables, such as age, education level, sex, and MS type influence disease progression. The present study focused on 2 sub-types of MS: relapsing remitting MS (RRMS) and secondary progressive MS (SPMS).

The investigators included 65 patients with MS, 49 of whom has RRMS and 16 had SPMS. The patients were recruited from the Multiple Sclerosis patient population from the University Hospital of León in Spain. The patients’ demographic information was collected during an interview and cognitive decline was evaluated using a neuropsychological assessment instrument.

The vast majority of the patients with RRMS were women (n = 41; 83.7%) and were aged 40 years or younger (n = 30; 61.2%). When divided by education level, 30.6% of the cohort had primary education (6 to 8 years of formal education), 42.9% had secondary education (8 to 12 years of formal education), and 26.5% had higher education (15 years or more of formal education).

Among the patients with SPMS, 56.2% (n = 9) were women and 68.7% (n = 11) were aged 40 years or older. By education level, 12.5% of the patients had primary education, 56.2% had secondary education, and 31.3% had higher education.

Multivariate analyses showed that patients with a higher education level had statistically significantly better verbal fluency (P < .005) compared with patients with a primary education level. Patients with a primary education level had a mean verbal fluency score of 21.03% and patients with a higher education level had a mean score of 36.44%.

Additionally, a nonparametric analysis revealed that compared with primary education levels, higher educational levels were associated with higher scores in logical memory (29.71 vs 34.67) and verbal fluency tests (21.02 vs 38.97).

The investigators found that sex was associated with short-term memory, which was statistically significantly impacted in women more than men (35.74 vs 25.26; P < .005). Age and MS type were not found to be associated with cognitive variables. Level of disability was found to be statistically significantly linked to differences in logical memory and verbal fluency during the multivariate logistic regression analysis.

The small sample size and the cross-sectional design of the study were listed as study limitations. Moreover, participant interviews did not include a question regarding how long their disease has lasted.

“We feel it would be useful to carry out a long-term longitudinal study in which newly diagnosed participants were grouped according to educational level and time since onset in order to determine whether these associations and correlations remain significant as regards long-term prognosis and this a putative protective effect,” the investigators said.


Estrada-López M, García-Martín S, Cantón-Mayo I. Cognitive Dysfunction in Multiple Sclerosis: Educational Level as a Protective Factor. Neurol Int. 2021;13(3):335-342. doi:10.3390/neurolint13030034