Education Associated With Better Recovery
From Traumatic Brain Injury
Released: 4/23/2014 12:25
Better-educated people appear to be significantly more likely to
recover from a moderate to severe traumatic brain injury (TBI),
suggesting that a brain’s “cognitive reserve” may play a role in
helping people get back to their previous lives, new Johns Hopkins
The researchers, reporting in the journal Neurology,
found that those with the equivalent of 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 a TBI serious enough to warrant inpatient
time in a hospital and rehabilitation facility.
The findings, while new among TBI investigators, mirror those in
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 its 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, Ph.D., an
epidemiologist at the Johns Hopkins University School of Medicine’s
Center for Surgical Trials and Outcomes Research. “Our work suggests
that cognitive reserve ¬— the brain's ability to be resilient in the
face of insult or injury — could account for the difference.”
Schneider conducted the research in conjunction with Robert D.
Stevens. M.D., a neuro-intensive care physician with Johns Hopkins’
Department of Anesthesiology and Critical Care Medicine.
For the study, the researchers studied 769 patients enrolled in the
TBI Model Systems database, an ongoing multi-center cohort of patients
funded by the National Institute on Disability and Rehabilitation
Research. The patients had been hospitalized with a moderate to severe
TBI and subsequently admitted to a rehabilitation facility.
Of the 769 patients, 219 — or 27.8 percent — were free of any
detectable disability one year after their injury. Twenty-three patients
who didn't complete high school — 9.7 percent of those at that
education level — recovered, while 136 patients with between 12 and 15
years of schooling — 30.8 percent of those at that educational level
— did. Nearly 40 percent of patients — 76 of the 194 — who had 16
or more years of education fully recovered.
Schneider 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.”
Meanwhile, he says, “What we learned may point to the potential
value of continuing to educate yourself and engage in cognitively
intensive activities. 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.”
Adds Stevens: “Understanding the underpinnings of cognitive reserve
in terms of brain biology could generate ideas on how to enhance
recovery from brain injury.”
Other Johns Hopkins researchers contributing to the study include
Vanessa Raymont, M.B.Ch.B., M.Sc., M.R.C.Psych.; Josh Duckworth, M.D.;
Robert G. Kowalski, M.B.B.Ch., M.S.; David
T. Efron, M.D.; Xuan Hui, M.D., Sc.M.; Shalini Selvarajah, M.D., M.P.H.;
and Hali L. Hambridge, Sc.M..
Schneider has pending patents on a treatment for acute central
nervous system injury, which are not related to the content of this
manuscript. Stevens has received funding from the Defense Advanced
Research Projects Agency, the Department of Defense and the Johns
Hopkins Brain Sciences Institute.
Hopkins Medicine (JHM), headquartered in Baltimore, Maryland, is a $6.7
billion integrated global health enterprise and one of the leading
health care systems in the United States. JHM unites physicians and
scientists of the Johns Hopkins University School of Medicine with the
organizations, health professionals and facilities of The Johns Hopkins
Hospital and Health System. JHM's vision, “Together, we will deliver
the promise of medicine,” is supported by its mission to improve the
health of the community and the world by setting the standard of
excellence in medical education, research and clinical care. Diverse and
inclusive, JHM educates medical students, scientists, health care
professionals and the public; conducts biomedical research; and provides
patient-centered medicine to prevent, diagnose and treat human illness.
JHM operates six academic and community hospitals, four suburban health
care and surgery centers, and more than 30 primary health care
outpatient sites. The Johns Hopkins Hospital, opened in 1889, was ranked
number one in the nation for 21 years in a row by U.S. News & World