Researchers studying the role of higher education in the mental health of people with MS have found that the brain is like any other muscle: Use it or lose it.

Italian researchers have found that multiple sclerosis patients with higher levels of education suffer less cognitive impairment than their less-educated counterparts.

Multiple sclerosis (MS) is a degenerative autoimmune disease that affects the central nervous system (CNS), composed of the brain, spinal cord, and optic nerves. The immune system launches an attack on the myelin sheath that insulates nerve cells and eventually destroys it. This damage disrupts nervous system signalling and can cause a wide array of physical symptoms, from numbness and tingling to total paralysis or blindness.

But there are also many invisible symptoms of MS, including a patient’s impaired ability to process information or perform mental tasks. Mental impairment can affect every aspect of a patient’s daily life, from job performance and relationships to the ability to perform routine tasks.

In this study, published this month in Restorative Neurology and Neuroscience, a patient’s cognitive reserve (CR), or the brain’s active attempt to focus on a task, was measured and evaluated based the patient’s level of education. In this case, a patient’s level of formal education, combined with his or her lifetime career achievements, determined the assigned CR status.

Not only did researchers want to evaluate the role of higher education in preventing cognitive decline in MS patients, but they also wanted to see how fatigue impacted the results. Fatigue is common in MS and it can often aggravate other symptoms.

For the study, 50 patients with MS and 157 control subjects were divided into groups according to their level of schooling. They were also classified further, using U.S. census categories, into low-level or high-level occupations. Students, housewives, and office workers were in the lower bracket, while the higher bracket was composed of management, professional, and technical workers.

To evaluate the participants’ mental acuity, researchers used a test known as the Paced Auditory Serial Addition Test (PASAT). The subject listens to a recording of random numbers between one and nine recited at three-second intervals. The goal is to add the first two numbers together, announce the sum, and then add the next number heard to the last one.

For example, the recording says “3….5” and the patient responds with “8”. The recording then says “9” and the next correct answer is “14”. The patient must ignore the previous sum and concentrate only on adding the next number they hear to the last number that was given.

This is a simple but challenging test, even for those who administer it. When someone is suffering from a cognitive deficit due to damage caused by MS, conquering this exam is nearly impossible. The patient can become easily distracted and confused or lose their place altogether.

The researchers found that patients with higher levels of education performed better on the PASAT than patients who had lower levels of education. However, although the PASAT is a standardized test widely used to assess mental ability in MS patients, it could be seen as biased against those who never excelled at math in school. Unless your occupation requires you to use math on a daily basis, how quickly you can add two single-digit numbers may not be a fair representation of your overall ability to process thoughts or perform tasks.

Researchers did find that those with a higher level of education appeared to have more cognitive reserve. For MS patients, this may lead to a whole new way of thinking about which therapies might benefit them.

“These results indicate that low education is a risk factor for cognitive impairment in people with neurological disease such as MS, whereas a high educational level could be considered a protective factor from disease-associated cognitive impairment,” observed lead investigator Elisabetta Làdavas, PhD, of the University of Bologna in Italy. In a press release, she concluded that “The protective effects of education on the cognitive profile of MS patients should be considered in longitudinal studies of cognitive functions, and in therapeutic attempts to improve cognition in these patients.”

So what can you do if you don’t have an Ivy League diploma hanging on your wall? The answer is exercise. Like any other muscle in the body, your brain will function better the more you challenge it.

There are numerous ways to give your brain a workout. Read books, play board games, do crossword puzzles, take up a hobby, or start a blog. The key is to apply brain power to learning something new.

Taking care of yourself is also critical, as the results showed that fatigue can play a role in cognitive decline. Get plenty of rest, eat a balanced diet, and talk to your doctor if fatigue is affecting your daily life. Your neurologist can help find ways to manage your cognitive issues as well as fatigue. Maybe studies like this will one day lead to doctors prescribing a game of Scrabble as routinely as they order drugs.