Cognitive reserve is the brain’s ability to adapt and protect against cognitive decline in the face of brain pathology: an individual with a higher cognitive reserve will express less cognitive decline as compared to someone with a lower reserve in the face of a similar extent of brain disease. The current practice is to infer the degree of cognitive reserve from multiple indicators including educational attainment or occupational complexity. This article reviewed previous studies to understand how cognitive reserve relates to cognitive performance in people with HIV. The researchers found that individuals with higher cognitive reserve tend to have better cognitive abilities despite brain aging or disease-related challenges. However, the study also noted variations in how cognitive reserve is measured and the need for further research in this area. Overall, the findings suggest that cognitive reserve plays a role in protecting against difficulties in people with HIV.


Cognitive reserve is a potential explanation for the disparity between brain pathology and its clinical manifestations. The main objective of this study was to estimate, based on published studies, the strength of the association between cognitive reserve and cognitive performance in individuals with HIV. A systematic literature search using Ovid MEDLINE, PsychINFO, and EMBASE was performed to identify studies published between 1990 and 2016 that quantified the association between cognitive reserve and cognitive performance in HIV. A random-effects meta-analysis was used to compute a summary estimate (Cohen’s d) with 95% confidence intervals(CI) and 95% prediction intervals (PI). The risk of bias and quality of reporting in the studies were indicated by the Appraisal tool for Cross-Sectional Studies (AXIS). Ten observational studies were deemed eligible. The pooled effect size was 0.9 (95% CI: 0.7–1.0; 95% PI: 0.4–1.4) with marked heterogeneity studies [Cochran’sQ(df = 9) = 28.0,p= .0009;I2 statistic = 67.4%]. Risk-of-bias appraisal showed that non-response bias was never addressed and the items associated with selection bias were only partially met. The association between cognitive reserve and cognitive performance suggests that building reserve through non-pharmacological interventions could be a potentially effective way of combating cognitive impairment in people with HIV.