Education Associated with Traumatic Brain Injury Recovery

People with more advanced education may be significantly more likely to recover from moderate to severe traumatic brain injury (TBI), suggesting that the brain’s “cognitive reserve” may have a part in recovery, researchers believe. The results were published in Neurology.

Investigators at Johns Hopkins University reported that study subjects with the equivalent of at least a college education are 7 times more likely than those who did not finish high school to be free of disability one year after a TBI that required inpatient stays in a hospital and rehabilitation facility.

Study leader Eric B. Schneider, PhD, an epidemiologist at the Johns Hopkins University School of Medicine’s Center for Surgical Trials and Outcomes Research, said some patients experience lifelong disability after this type of brain injury, while others with very similar damage achieve a full recovery. The team’s work suggests that cognitive reserve, the brain’s ability to be resilient after insult or injury, could explain the difference.

The study followed 769 patients enrolled in the TBI Model Systems database, a cohort of patients funded by the National Institute on Disability and Rehabilitation Research. They had been hospitalized with moderate to severe TBI and then admitted to a rehabilitation facility.

Of the 769 patients, 219 (27.8%) were free of any detectable disability one year post injury. Just 23 of the patients who recovered didn’t complete high school (9.7% of those at that educational level), whereas 136 patients with 12 to 15 years of schooling (30.8% of those at that educational level) did. Nearly 40% of patients who had 16 or more years of education fully recovered.

Researchers don’t currently understand the biological mechanisms that might account for the link between years of schooling and better recovery. They hypothesize that people with increased cognitive reserve capabilities may heal in a way that allows them to return to pre-injury function or they may adapt better and form new pathways in their brains to compensate for the injury.