Cognitive Reserve Boosts Recovery After TBI?

May 07, 2014

People with more years of education may be better able to recover from a traumatic brain injury, a new study suggests.

The study, published in the April 23 online issue of Neurology, was led by Eric B. Schneider, PhD, from Johns Hopkins School of Medicine, Baltimore, Maryland.

He and his team found that individuals who attended education for 12 to 15 years (ie, those who had some postsecondary education) were almost 5 times more likely to recover without disability compared with those with less than 12 years' education (ie, those who didn't finish high school). And those with 16 or more years of education (ie, those who had at least an undergraduate degree) were 7 times more likely to recover without disability.

The researchers conclude: "Educational attainment was a robust independent predictor of 1-year DFR [disability-free recovery] even when adjusting for other prognostic factors. A dose-response relationship was noted ...This suggests that cognitive reserve could be a factor driving neural adaptation during recovery from TBI [traumatic brain injury]."

Dr. Schneider commented: "We need to learn more about how education helps to protect the brain and how it affects injury and resilience. Exploring these relationships will hopefully help us to identify ways to help people recover better from traumatic brain injury."

Cognitive Reserve

The cognitive reserve theory suggests that people with more education have a greater cognitive reserve, or the brain’s ability to maintain function despite damage, the researchers explain. This concept first emerged for brain disorders, such as Alzheimer’s disease, where people with higher levels of education have been shown to have fewer symptoms of the disease than people with less education, even when they have the same amount of damage in the brain from the disease. But few studies have looked at how cognitive reserve may affect traumatic brain injury.

For the study, Dr. Schneider and colleagues analyzed data on patients from a US national database on traumatic brain injury. Patients were included in the study if they were admitted for rehabilitation after moderate to severe traumatic brain injury, were aged 23 years or older, and had at least 1 year of follow-up.

Results showed that of the 769 patients included, disability-free recovery at 1 year after injury was achieved by 214 (27.8%). Patients with more years of education were more likely to recover without disability.

Table. Disability-Free Recovery at 1 Year by Years of Education

Years of Education Patients Achieving Disability-Free Recovery at 1 Year (%)
<12 9.7
12 - 15 30.8
≥16 39.2


In a logistic regression model controlling for age, sex, and injury- and rehabilitation-specific factors, duration of education of 12 years or more was independently associated with disability-free recovery.

Stronger Networks

In an accompanying Comment, Erin D. Bigler, PhD, Brigham Young University, Provo, Utah, notes that neuroimaging studies have shown that brain networks can be strengthened by educational training, and cognitive reserve has also been shown to be a factor related to resiliency in aging and the timing and expression of dementia.

He adds that the current study and others "firmly establish" a role for cognitive reserve in traumatic brain injury outcome.

Neurology. 2014;82:1636-1642. Abstract Comment


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