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Multicenter Study
. 2014 May 6;82(18):1636-42.
doi: 10.1212/WNL.0000000000000379. Epub 2014 Apr 23.

Functional recovery after moderate/severe traumatic brain injury: a role for cognitive reserve?

Eric B Schneider  1 , Sandeepa Sur, Vanessa Raymont, Josh Duckworth, Robert G Kowalski, David T Efron, Xuan Hui, Shalini Selvarajah, Hali L Hambridge, Robert D Stevens
Affiliations
Multicenter Study

Functional recovery after moderate/severe traumatic brain injury: a role for cognitive reserve?

Eric B Schneider et al. Neurology. .

Abstract

Objective: To evaluate the hypothesis that educational attainment, a marker of cognitive reserve, is a predictor of disability-free recovery (DFR) after moderate to severe traumatic brain injury (TBI).

Methods: Retrospective study of the TBI Model Systems Database, a prospective multicenter cohort funded by the National Institute on Disability and Rehabilitation Research. Patients were included if they were admitted for rehabilitation after moderate to severe TBI, were aged 23 years or older, and had at least 1 year of follow-up. The main outcome measure was DFR 1 year postinjury, defined as a Disability Rating Scale score of zero.

Results: Of 769 patients included, 214 (27.8%) achieved DFR at 1 year. In total, 185 patients (24.1%) had <12 years of education, while 390 (50.7%) and 194 patients (25.2%) had 12 to 15 years and ≥16 years of education, respectively. DFR was achieved by 18 patients (9.7%) with <12 years, 120 (30.8%) with 12 to 15 years, and 76 (39.2%) with ≥16 years of education (p < 0.001). In a logistic regression model controlling for age, sex, and injury- and rehabilitation-specific factors, duration of education of ≥12 years was independently associated with DFR (odds ratio 4.74, 95% confidence interval 2.70-8.32 for 12-15 years; odds ratio 7.24, 95% confidence interval 3.96-13.23 for ≥16 years).

Conclusion: Educational attainment was a robust independent predictor of 1-year DFR even when adjusting for other prognostic factors. A dose-response relationship was noted, with longer educational exposure associated with increased odds of DFR. This suggests that cognitive reserve could be a factor driving neural adaptation during recovery from TBI.

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Conflict of interest statement

E. Schneider has pending patents on a treatment for acute CNS injury, which are not related to the content of this report. S. Sur, V. Raymont, J. Duckworth, R. Kowalski, D. Efron, X. Hui, S. Selvarajah, and H. Hambridge report no disclosures relevant to the manuscript. R. Stevens has received funding from the Defense Advanced Research Projects Agency, the Department of Defense, and from the Johns Hopkins Brain Sciences Institute. Go to Neurology.org for full disclosures.

Figures

Figure 1
Figure 1. Study flow diagram
TBI Model Systems patients eligible, included, and excluded in the study, including reasons for exclusion. DRS = Disability Rating Scale; ED = emergency department; GCS = Glasgow Coma Scale; LOS = length of stay; TBI = traumatic brain injury.
Figure 2
Figure 2. DRS scores at admission to rehabilitation and at 1 year
Mean (95% confidence interval) Disability Rating Scale (DRS) scores on admission to rehabilitation and at 1 year in patients grouped by years of education.
Figure 3
Figure 3. DRS score distribution
Distribution of Disability Rating Scale (DRS) scores on admission to rehabilitation and 1 year postinjury in patients grouped by years of education.
See this image and copyright information in PMC

Comment in

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