Psychological resilience as a behavioral proxy for cognitive reserve in multiple sclerosis: A theoretical reappraisal.

Psychological resilience has emerged as a robust protective factor in multiple sclerosis (MS), consistently associated with reduced depression, lower fear of relapse, and improved health-related quality of life. However, resilience in MS has been predominantly conceptualized as an intrapersonal psychological trait, limiting its explanatory scope for cognitive and neurological outcomes. In this theoretical manuscript, we propose reconceptualizing psychological resilience as a dynamic behavioral-psychological system that may function as a behavioral proxy for cognitive reserve. This proposal is grounded in converging evidence indicating that resilience is associated with sustained engagement in behaviors known to support cognitive reserve, including physical activity, social participation, and adaptive health self-management. While direct causal relationships remain to be established, this framework offers an integrative perspective linking psychological adaptation, behavioral engagement, and neuroprotection in MS and related neurodegenerative conditions.