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Understanding more about how education influences recovery from traumatic brain injury could help doctors do more for all TBI patients, researchers say. (Credit: iStockphoto)

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Educated brains recover better after injury

Better-educated people appear more likely to fully recover from traumatic brain injury, suggesting that “cognitive reserve” may help their brains to mend, research shows.

Scientists found that those with at least a college education are seven times more likely than those who didn’t finish high school to be disability-free one year after moderate or severe traumatic brain injury (TBI).

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The findings, reported online by the journal Neurology, are new among TBI investigators. They mirror, however, those from Alzheimer’s disease research, in which higher educational attainment—believed to be an indicator of a more active, or more effective, use of the brain’s “muscles” and therefore of more cognitive reserve—has been linked to slower progression of dementia.

“After this type of brain injury, some patients experience lifelong disability, while others with very similar damage achieve a full recovery,” says study leader Eric B. Schneider, an epidemiologist at the Johns Hopkins University School of Medicine.

“What we learned [in the study] may point to the potential value of continuing to educate yourself and engage in cognitively intensive activities,” Schneider says. “Just as we try to keep our bodies strong in order to help us recover when we are ill, we need to keep the brain in the best shape it can be.”

Schneider describes cognitive reserve as “the brain’s ability to be resilient in the face of insult or injury.” He says researchers don’t currently understand the biological mechanisms that might account for the link between years of schooling and improved recovery.

“People with increased cognitive reserve capabilities may actually heal in a different way that allows them to return to their pre-injury function and/or they may be able to better adapt and form new pathways in their brains to compensate for the injury,” Schneider says. “Further studies are needed to not only find out, but also to use that knowledge to help people with less cognitive reserve.”

Full recovery

Schneider conducted the research with Robert D. Stevens, a neuro-intensive care physician with Johns Hopkins’ department of anesthesiology and critical care medicine. They studied 769 patients who had been hospitalized with a moderate to severe TBI and subsequently admitted to a rehabilitation facility.

Of those patients, 219—or 27.8 percent—were free of any detectable disability one year after their injury. Fewer than 10 percent of those who had not completed high school recovered. On the other hand, nearly 31 percent of those with between 12 and 15 years of schooling and nearly 40 percent of patients with 16 or more years of education fully recovered.

When adjusted for other factors, such as race, injury severity, and length of stay in rehabilitation, the advantage for the most highly educated patients is seven-fold, Schneider says.

“Understanding the underpinnings of cognitive reserve in terms of brain biology could generate ideas on how to enhance recovery from brain injury,” Stevens says.

Stevens has received funding from the Defense Advanced Research Projects Agency, the Department of Defense, and the Johns Hopkins Brain Sciences Institute.

Source: Johns Hopkins University

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