Johns Hopkins study: Education mitigates the effects of brain injury

24 Apr

Education Portal defines illiteracy in the article, Illiteracy: The Downfall of American Society.

Most people think of literacy as a simple question of being able to read. But while a young child who can work her way through a basic picture book is considered to have age-appropriate literacy levels, an adult who can only read at the most fundamental level is still functionally illiterate.
The world requires that adults not only be able to read and understand basic texts, but also be able to function in the workplace, pay bills, understand legal and financial documents and navigate technology – not to mention the advanced reading comprehension skills required to pursue postsecondary education and the opportunities that come with it.
As a result, when we talk about the effects of illiteracy on society, we’re talking primarily about what happens when you have a large number of adults whose literacy skills are too low to perform normal, day-to-day tasks. However, it is worth keeping in mind that childhood illiteracy is, of course, directly correlated to adult illiteracy.

The key concept is the individual cannot adequately function in the society in which they live. That means that tasks necessary to provide a satisfactory life are difficult because they cannot read and/or comprehend what they read.
Research is taking the concept of literacy a step farther with the concept of cognitive reserve.

Jon Hamilton of NPR reported in the article, Education May Help Insulate The Brain Against Traumatic Injury:

A little education goes a long way toward ensuring you’ll recover from a serious traumatic brain injury. In fact, people with lots of education are seven times more likely than high school dropouts to have no measurable disability a year later.
“It’s a very dramatic difference,” says Eric Schneider, an epidemiologist at Johns Hopkins and the lead author of a new study. The finding suggests that people with more education have brains that are better able to “find ways around the damage” caused by an injury, he says.
The study looked at the medical records of 769 adults who suffered traumatic brain injuries serious enough to require an inpatient hospital stay and rehabilitation. A year after the injury, just 10 percent of people who didn’t finish high school had no disability, compared with 39 percent of people with enough years of education to have received a college degree. People with advanced degrees did even better.
One reason for the difference may be something known as “cognitive reserve” in the brain, Schneider says. The concept is a bit like physical fitness, he says, which can help a person recover from a physical injury. Similarly, a person with a lot of cognitive reserve may be better equipped to recover from a brain injury…
For several decades, studies have shown that people with more education, and presumably more cognitive reserve, are less likely to develop the memory and thinking problems of Alzheimer’s disease. The new study suggests the benefits of education and cognitive reserve extend to brain damage caused by injury rather than disease.
There’s no guaranteed way to increase your cognitive reserve, Schneider says. But there are hints that staying physically and socially active helps, and that “pursuing lifelong learning may be beneficial,” he says.
One limitation of the study is that it relied on a standard disability rating scale, which relies on measures such as a person’s ability to return to work. That could have meant that a college graduate returning to an office job was less likely to be declared disabled than, “a roofer with balance issues,” Schneider says. He adds that even people with a disability rating of zero may still have mental or physical problems caused by their brain injury.


Functional recovery after moderate/severe traumatic brain injury
A role for cognitive reserve?
1. Eric B. Schneider, PhD,
2. Sandeepa Sur, MSc, MHS,
3. Vanessa Raymont, MBChB, MSc, MRCPsych,
4. Josh Duckworth, MD,
5. Robert G. Kowalski, MBBCh, MS,
6. David T. Efron, MD,
7. Xuan Hui, MD, ScM,
8. Shalini Selvarajah, MD, MPH,
9. Hali L. Hambridge, ScM and
10. Robert D. Stevens, MD
1. From the Center for Surgical Trials and Outcomes Research, Department of Surgery (E.B.S., D.T.E., X.H., S. Selvarajah, H.L.H.), Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine (R.G.K., R.D.S.), and Departments of Neurology (R.D.S.) and Neurosurgery (R.D.S.), Johns Hopkins School of Medicine, Baltimore, MD; Tulane Center for Aging (S. Sur), Tulane University School of Medicine, New Orleans, LA; Department of Radiology (V.R., J.D., R.D.S.), Johns Hopkins University, Baltimore, MD; and Centre for Mental Health (V.R.), Department of Medicine, Imperial College London, UK.
1. Correspondence to Dr. Schneider:
1. Published online before print April 23, 2014, doi: 10.1212/WNL.0000000000000379 Neurology 10.1212/WNL.0000000000000379
» Abstract
Full Text (PDF)
1. Also available:
2. Accompanying Comment
Objective: To evaluate the hypothesis that educational attainment, a marker of cognitive reserve, is a predictor of disability-free recovery (DFR) after moderate to severe traumatic brain injury (TBI).
Methods: Retrospective study of the TBI Model Systems Database, a prospective multicenter cohort funded by the National Institute on Disability and Rehabilitation Research. Patients were included if they were admitted for rehabilitation after moderate to severe TBI, were aged 23 years or older, and had at least 1 year of follow-up. The main outcome measure was DFR 1 year postinjury, defined as a Disability Rating Scale score of zero.
Results: Of 769 patients included, 214 (27.8%) achieved DFR at 1 year. In total, 185 patients (24.1%) had <12 years of education, while 390 (50.7%) and 194 patients (25.2%) had 12 to 15 years and ≥16 years of education, respectively. DFR was achieved by 18 patients (9.7%) with <12 years, 120 (30.8%) with 12 to 15 years, and 76 (39.2%) with ≥16 years of education (p < 0.001). In a logistic regression model controlling for age, sex, and injury- and rehabilitation-specific factors, duration of education of ≥12 years was independently associated with DFR (odds ratio 4.74, 95% confidence interval 2.70–8.32 for 12–15 years; odds ratio 7.24, 95% confidence interval 3.96–13.23 for ≥16 years).
Conclusion: Educational attainment was a robust independent predictor of 1-year DFR even when adjusting for other prognostic factors. A dose-response relationship was noted, with longer educational exposure associated with increased odds of DFR. This suggests that cognitive reserve could be a factor driving neural adaptation during recovery from TBI.
Received July 18, 2013.
Accepted in final form January 21, 2014.
© 2014 American Academy of Neurology

Cognitive reserve is the key concept in interpreting this study.

Molly Edmonds wrote in the How Stuff Works article, Can you delay dementia?

But don’t get downhearted; even if you didn’t go for that Ph.D., you can still start challenging the brain at any age to build up cognitive reserve. Software and video games meant to challenge the brain have begun popping up on the market, though scientists warn that these tools don’t have much science behind them [sources: Belluck, Larson]. You don’t even have to get that high-tech. In one study, participants who worked a crossword puzzle four days of the week had a 47 percent lower risk of dementia than those who did a crossword once a week . Mental activities like playing chess and other board games, learning a foreign language, volunteering, reading and playing a musical instrument all keep the brain humming. Finding a friend to do some of these activities with is also a bonus — in a study that examined over 1,000 people, those with a limited social network were 60 percent more likely to have dementia after a three-year period .
For a real-life example of how cognitive reserve can delay dementia, look no further than the 678 Catholic Sisters of Notre Dame, of Mankato, Minn. These nuns’ cognitive states were studied for years as doctors tried to learn more about dementia, and doctors conducted postmortem exams on the women’s brains. In one examination, doctors found that some of the nuns who had signs of Alzheimer’s disease in the brain hadn’t demonstrated a lack of cognitive function while still alive. The doctors did notice that the blood vessels in the brain were in exceptionally good shape, however, meaning that even as Alzheimer’s started to appear, the brain found a way to work around the challenges [sources: Whitehouse, Tan]. That’s not to say that cognitive reserve can delay dementia forever — if the women had lived longer, they may have developed dementia eventually.
Your brain depends on a regular flow of blood, so another way to keep those cerebral blood vessels working well is good old-fashioned exercise. Read on to find out what other physical activities can help your brain.

Just as one must exercise their body to stay healthy, they must also exercise their brain.

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