Time to hit the books? Education level impacts TBI recovery

Those who have more years of education could recover better from a traumatic brain injury (TBI), according to a study published online April 23 by Neurology.

Some patients experience lifelong disability after a moderate to severe TBI, while others with similar clinical characteristics are able to fully recover from the trauma. “This heterogeneity in outcome has been linked to patient- and injury-specific factors as well as physiologic disturbances encountered in the acute setting,” wrote the study’s lead author, Eric B. Schneider, PhD, of the Johns Hopkins School of Medicine in Baltimore and colleagues. “However, existing prognostic models fail to provide a full accurate account of the variance seen in TBI recovery.”

Because cognitive reserve has been identified as a contributor to the degree to which brain disorders are phenotypically expressed and educational attainment is widely accepted as a valid surrogate marker for underlying cognitive reserve, Schneider and colleagues investigated the hypothesis that educational attainment is a predictor of disability-free recovery (DFR) after moderate to severe traumatic brain injuries.

The study included 769 people who were at least 23 years old and had been followed for a minimum of year after their moderate to severe TBIs. Most were attributed to car accidents or falls and all were taken to the emergency department and spent time in the hospital after injury and underwent inpatient rehabilitation. The researchers grouped participants by their education level, resulting in the following classifications: 185 people, or 24.1 percent, did not finish high school; 390, or 50.7 percent, had 12 to 15 years of education or had finished high school and some post-secondary education; and 194, or 25.2 percent, had obtained at least an undergraduate degree or had 16 or more years of education.

A year after injury, 219 participants (27.8 percent) had no disability and were able to return to work or school. Twenty-three people (9.7 percent) with no high school diploma were free of disability, while 136 (30.8 percent) with some college education and 76 (39.2 percent) of those with a college degree were disability-free.

“Research is needed to elucidate the biological mechanisms of cognitive reserve and how this process is related to learning, education, injury, and resilience. It is expected that exploring these relationships will help identify interventions to promote greater degrees of recovery after TBI,” wrote the authors.

In an associated editorial, Erin D. Bigler, PhD, of Brigham Young University in Provo, Utah, wrote: “Of course, caution is needed so as not to overinterpret the role of educational attainment. The Disability Rating Scale is but a rating scale with low and overly broad thresholds that lead to DFR classification. Nonetheless, because the brain is an experience-dependent organ, educational attainment must reflect neural integrity at some level, which in turn represents an important factor for the clinician to consider in understanding TBI outcome.”