# Multidimensional cognitive reserve and cognitive outcomes in glioblastoma: a pre- and postoperative analysis

## TL;DR

This study explores how cognitive reserve, including education and lifestyle, affects cognitive function in glioblastoma patients before and after surgery.

## Contribution

The study introduces a multidimensional assessment of cognitive reserve and its differential impact on cognitive outcomes in glioblastoma patients.

## Key findings

- Higher cognitive reserve predicts better preoperative performance in global deficit, executive function, memory, and recognition memory.
- Education directly affects executive function, independent of lifestyle activities.
- Work and leisure activities are linked to better recognition memory in the acute postoperative phase.

## Abstract

Glioblastoma (GBM) is the most aggressive primary brain tumour in adults. One factor which is widely considered to have protective effects for cognition in age-related decline is cognitive reserve. However, little research has been done into the relationship between cognitive reserve and cognitive function in GBM. We investigated whether a multidimensional construct of cognitive reserve predicts cognitive outcomes before and after surgery.

43 adult patients with GBM (mean age = 62) took the Cognitive Reserve Index Questionnaire and participated in the OCS-BRIDGE cognitive screen at preoperatively, at 72 h and 6–8 weeks postoperatively. Linear regressions and mediation analyses assessed the relationship between cognitive reserve proxies (education, work and leisure) and cognitive performance across domains.

Higher overall cognitive reserve significantly predicted better preoperative performance in global deficit, executive function, memory and recognition memory. Mediation analysis revealed that education had a direct effect on executive function, independent of lifestyle activities. Postoperatively, most protective effects of cognitive reserve diminished. However, recognition memory at 72 h remained significantly associated with cognitive reserve, specifically work and leisure activities, as revealed by the mediation analysis.

Cognitive reserve protects against tumour-related cognitive deficits, and in executive function, this is primarily driven by education. In contrast, “active” reserve components, such as work and leisure, may support recognition memory during the acute postoperative phase. These findings highlight the distinct clinical utility of multidimensional reserve assessment for preoperative risk stratification and potential prehabilitation.