Research Reports - Contribution of brain or biological reserve and cognitive or neural reserve to outcome after TBI

Neurosci Biobehav Rev. 2015 Jun 6;55:573-593

Mathias JL(1), Wheaton P(2)

Brain/biological (BR) and cognitive/neural reserve (CR) have increasingly been
used to explain some of the variability that occurs as a consequence of normal
ageing and neurological injuries or disease. However, research evaluating the
impact of reserve on outcomes after adult traumatic brain injury (TBI) has yet to
be quantitatively reviewed. This meta-analysis consolidated data from 90 studies
(published prior to 2015) that either examined the relationship between measures
of BR (genetics, age, sex) or CR (education, premorbid IQ) and outcomes after TBI
or compared the outcomes of groups with high and low reserve. The evidence for
genetic sources of reserve was limited and often contrary to prediction. APOE ∈4
status has been studied most, but did not have a consistent or sizeable impact on
outcomes. The majority of studies found that younger age was associated with
better outcomes, however most failed to adjust for normal age-related changes in
cognitive performance that are independent of a TBI. This finding was reversed
(older adults had better outcomes) in the small number of studies that provided
age-adjusted scores; although it remains unclear whether differences in the cause
and severity of injuries that are sustained by younger and older adults
contributed to this finding. Despite being more likely to sustain a TBI, males
have comparable outcomes to females. Overall, as is the case in the general
population, higher levels of education and pre-morbid IQ are both associated with
better outcomes.

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