In recovering from brain trauma, it helps to have stayed in school

The extra brainpower that comes with having spent more years in a classroom is a powerful aid to recovery following a moderate to severe brain trauma, a new study finds.

Researchers have long known that cognitive reserve -- a level of mental engagement that may come from reading books, staying mentally and socially active and pursuing an education -- forestalls the appearance of dementia and memory loss symptoms in those whose brains are under attack by Alzheimer’s Disease. Mentally active patients living with multiple sclerosis and HIV/AIDS encephalopathy also appear to fare better than those who have developed less brainpower, even as their diseases progress.

The latest study, which followed patients hospitalized following a head injury, is the first to show that cognitive reserve matters, as well, when the brain is reeling from the shock of injury. It was published this week in the journal Neurology.

Educational attainment is not the only way to build up the kind of “cognitive reserve” that can help the brain function better when under assault from injury or disease. But the mental habits that come with more schooling consistently make the brain more flexible and resilient against insults, allowing a person to devise strategies to compensate for or work around mental impairments. Studies suggest that taking on regular mental challenges -- from newspaper-reading to teaching to crossword puzzles -- can also build a cognitive reserve capable of holding off mental decline.

In the wake of the January 2011 shooting of then-Congresswoman Gabrielle Giffords in Tucson, Ariz., this reporter wrote a series of articles on recovering from penetrating brain injury, with profiles of several people who were living with the consequences of a grievous head wound. The story of Jackie Nink Pflug, a teacher shot in the head at point-blank range during a 1985 hijacking, was among them. Her struggle back from total cognitive devastation is a truly remarkable story of the power of intellect to drive recovery, and you can read it here.

This study, conducted by researchers at Johns Hopkins University, Tulane University and Imperial College London, used educational attainment as a rough surrogate for mental engagement, and tracked 769 patients hospitalized for brain injury for a year, to see which ones were most likely to be free of disability 12 months after their accident.

In all, 214 patients (27.6%) regained full function after a year. Among those patients with the least education (fewer than 12 years), 9.7% were free of significant disability after a year. For those who completed between 12 and 15 years of education, the proportion of those without major disability after a year was 30.8%. And for those with 16 or more years of education -- a college or advanced degree -- 39.2% had regained their full function.

The researchers also found a “dose response” relationship between education and recovery: Even within the broad categories of educational attainment, the likelihood of being disability-free rose with each additional year of schooling a victim of brain injury had completed.

The researchers acknowledge that a patient’s socio-economic status can be a powerful influence in his or her recovery, as can individual factors such as motivation to succeed and self-discipline. All those factors tend to slide up and down along with educational attainment, making education a rough stand-in for a range of factors important in recovering from brain injury.