Research Reports - Education attenuates the negative impact of traumatic brain injury on cognitive status

Arch Phys Med Rehabil. 2013 Dec;94(12):2562-4

Sumowski JF, Chiaravalloti N, Krch D, Paxton J, Deluca J

OBJECTIVE: To investigate whether the cognitive reserve hypothesis helps to
explain differential cognitive impairment among survivors of traumatic brain
injury (TBI), whereby survivors with greater intellectual enrichment (estimated
with education) are less vulnerable to cognitive impairment.
DESIGN: Cross-sectional study.
SETTING: Medical rehabilitation research center.
PARTICIPANTS: Survivors of moderate or severe TBI (n=44) and healthy controls
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Intellectual enrichment was estimated with educational
attainment. Group was defined as TBI or healthy control. Current cognitive status
(processing speed, working memory, episodic memory) was evaluated with
neuropsychological tasks.
RESULTS: TBI survivors exhibited worse cognitive status than healthy persons
(P<.001), and education was positively correlated with cognitive status in TBI
survivors (r=.54, P<.001). Most importantly, regression analysis revealed an
interaction between group and education (R(2) change=.036, P=.004), whereas
higher education attenuated the negative impact of TBI on cognitive status. TBI
survivors with lower education performed much worse than matched healthy persons,
but this TBI-related performance discrepancy was attenuated at higher levels of
CONCLUSIONS: Higher intellectual enrichment (estimated with education) reduces
the negative effect of TBI on cognitive outcomes, thereby supporting the
cognitive reserve hypothesis in persons with TBI. Future work is necessary to
investigate whether intellectual enrichment can build cognitive reserve as a
rehabilitative intervention in survivors of TBI.

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