Cognitive Reserve and Symptom Experience in Multiple Sclerosis: A Buffer to Disability Progression Over Time? Carolyn E. Schwartz, ScD, Brian R. Quaranto,

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Cognitive Reserve and Symptom Experience in Multiple Sclerosis: A Buffer to Disability Progression Over Time? Carolyn E. Schwartz, ScD, Brian R. Quaranto, BS, Brian C. Healy, PhD, Ralph H. Benedict, PhD, Timothy L. Vollmer, MD Archives of Physical Medicine and Rehabilitation Volume 94, Issue 10, Pages 1971-1981.e1 (October 2013) DOI: 10.1016/j.apmr.2013.05.009 Copyright © 2013 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 1 Cross-sectional comparison of cognitive reserve groups by Symptom Inventory subscale means. This radar plot shows the mean scores for each Symptom Inventory scale for the 4 cognitive reserve groups. Scores closer to the center reflect lower symptom burden, and further from the center reflect higher symptom burden. Abbreviation: Vaso, vasomotor. Archives of Physical Medicine and Rehabilitation 2013 94, 1971-1981.e1DOI: (10.1016/j.apmr.2013.05.009) Copyright © 2013 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 2 Longitudinal comparison of cognitive reserve groups Performance Scales domain trajectory slopes. This radar plot shows the trajectory score means for 6 years of follow-up on the Performance Scales domain scores for the 4 cognitive reserve groups. The black dashed line highlights the “zero” circle, with scores closer to the center of the radar indicating negative trajectories (ie, reduction of disability), and scores further from the center indicating positive trajectories (ie, increased disability). Patients with high-active cognitive reserve show significantly less deterioration in mobility, fatigue, and the Performance Scales summary score (see table 4). Archives of Physical Medicine and Rehabilitation 2013 94, 1971-1981.e1DOI: (10.1016/j.apmr.2013.05.009) Copyright © 2013 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 3 Classification and regression tree of active reserve items distinguishing mild-disability subgroup. The bottom row of the tree diagram shows the 15 final groupings of the patients with mild disability on the basis of their answers to the Stern Leisure Activities Measure. At each split, lower scores went to the left, and higher scores went to the right. The number of patients in each terminal node and the mean score of patients in that node are provided below the terminal node. Abbreviations: CART, classification and regression tree; obs, observations; PDDS, Patient-Determined Disease Steps. Archives of Physical Medicine and Rehabilitation 2013 94, 1971-1981.e1DOI: (10.1016/j.apmr.2013.05.009) Copyright © 2013 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 4 Classification and regression tree of active reserve items distinguishing severe-disability subgroup. The bottom row of the tree diagram shows the 9 final groupings of the patients with severe disability on the basis of their answers to the Stern Leisure Activities Measure. At each split, lower scores went to the left, and higher scores went to the right. The number of patients in each terminal node and the mean score of patients in that node are provided below the terminal node. Abbreviations: CART, classification and regression tree; obs, observations; PDDS, Patient-Determined Disease Steps. Archives of Physical Medicine and Rehabilitation 2013 94, 1971-1981.e1DOI: (10.1016/j.apmr.2013.05.009) Copyright © 2013 American Congress of Rehabilitation Medicine Terms and Conditions

Supplemental Figure S1 Classification and regression tree of active reserve items distinguishing moderate-disability subgroup. The bottom row of the tree diagram shows the 12 final groupings of the patients with mild disability on the basis of their answers to the Stern Leisure Activities Measure. At each split, lower scores went to the left, and higher scores went to the right. The number of patients in each terminal node and the mean score of patients in that node are provided below the terminal node. Abbreviations: CART, classification and regression tree; obs, observations; PDDS, Patient-Determined Disease Steps. Archives of Physical Medicine and Rehabilitation 2013 94, 1971-1981.e1DOI: (10.1016/j.apmr.2013.05.009) Copyright © 2013 American Congress of Rehabilitation Medicine Terms and Conditions