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

Sophie Rauch, Yizhou Wan, Ajay Halai, Tom Manly, Haiyan Zheng, Roxanne Mayrand, Rohitashwa Sinha, Alexis Joannides, Richard Mair, Robert Morris, Thomas Santarius, Matthew Lambon-Ralph, Stephen J. Price

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose
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.

Method
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.

Results
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.

Conclusion
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.
Original languageEnglish
Article number11
JournalJournal of Neuro-Oncology
Volume177
Issue number1
Early online date21 Feb 2026
DOIs
Publication statusE-pub ahead of print - 21 Feb 2026

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author, SR. The data are not publicly available due to their containing information that could compromise the privacy of research participants.

Funding

This study was funded from the National Institute for Health and Care Research (NIHR), Career Development Fellowship (CDF-2018-11-ST2-003 to SJP.) This work was supported by the NIHR HealthTech Research Centre in Brain Injury and the NIHR Cambridge Biomedical Research Centre (NIHR203312) and the Assessing impact of surgically-induced deficits on patient functioning and quality of life (SIND study) (19/WM/0152). This publication presents independent research funded by the National Institute for Health and Care Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

FundersFunder number
National Institute for Health and Care ResearchCDF-2018-11-ST2-003
NIHR Cambridge Biomedical Research CentreNIHR203312, 19/WM/0152

    UN SDGs

    This output contributes to the following UN Sustainable Development Goals (SDGs)

    1. SDG 3 - Good Health and Well-being
      SDG 3 Good Health and Well-being

    Keywords

    • Cognition
    • Cognitive reserve
    • Glioblastoma
    • Neuropsychological assessment

    ASJC Scopus subject areas

    • Oncology
    • Neurology
    • Clinical Neurology
    • Cancer Research

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