Cognitive reserve is a concept that refers to the brain’s ability to better cope with brain-deterioration conditions, and acts as a compensation mechanism in order to minimize their symptoms. Cognitive reserve is associated with different levels of evolution of severe mental illness. Spanish researchers propose that the level of cognitive reserve should be observed as an indicator of the evolution of these patients and point out its usefulness in the design of the therapeutic strategy.
Researchers from the Center for Biomedical Research in Network for Mental Health (CIBERSAM), led by the group coordinated by Miquel Bernardo at the Hospital Clínic of Barcelona, stressed the important role of cognitive reserve in the evolution of serious mental disorders, such as first psychotic episodes. This considerations are based on a study, carried out under the PEPs project (genotype-phenotype and environment interaction), which was recently published in the journal Acta Psychiatrica Scandinavica.
In this study, whose first authors are Sílvia Amoretti and Bibiana Cabrera and which included the participation of researchers from 15 groups of CIBERSAM, the predictive role of this function in the evolution of first affective and non-affective psychotic episodes was analyzed.
“The work arises from the need to take into account the concept of cognitive reserve in first psychotic episodes, since it has been observed that it can be an essential element that substantially influences the evolution, functionality and quality of life of patients“, explains Sílvia Amoretti.
For this, the researchers analyzed cases of first psychotic episodes in a total of 247 patients (211 non-affective and 36 affective), who were classified into groups according to their level (high or low) of their cognitive reserve.
The study allowed to conclude that the level of cognitive reserve exerts a differential role according to the diagnosis of the first psychotic affective episode (those in which the psychotic symptoms are linked to the state of mind, such as bipolar disorder I and II or the manic and depressive episodes with psychotic symptoms) or non-affective (such as schizophrenia, schizoaffective disorders and other unspecified psychoses).
Specifically, in the group of non-affective psychoses, those patients with high cognitive reserve showed a better performance in all the cognitive domains evaluated, with the exception of the executive functions.
In contrast, in the group of affective psychoses, significant differences in functionality and verbal memory were observed.
Usefulness in the design of the therapeutic strategy
According to these results, the authors suggest that to address the needs of non-affective patients with low cognitive reserve, cognitive rehabilitation interventions could be proposed. In contrast, for affective patients with low cognitive reserve, functional remediation would be proposed.
“Although more scientific evidence and longitudinal studies are needed to analyze the effectiveness of specific treatments based on the level of cognitive reserve, their identification can significantly improve the understanding of individual differences in neuropsychiatric disorders,” says Bibiana Cabrera.
Likewise, “cognitive reserve may be useful as a stratification tool in patients with a first psychotic episode, as a first step in the implementation of personalized interventions,” says Miquel Bernardo.