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People with more education may recover better from brain injury

New research suggests that people with more education recover significantly better from serious head injuries.

Scientists from Johns Hopkins University in Baltimore found that adults with moderate to severe traumatic brain injuries who had earned at least an undergraduate degree were more than seven times as likely to completely recover from their injury than those who didn't finish high school.

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The research focused on how "cognitive reserve" -- the brain's ability to maintain function despite damage -- affects recovery from traumatic brain injury. The results echo previous research in Alzheimer's dementia suggesting that more years of education, believed to lead to more effective brain use and greater cognitive reserve, slows progression of symptoms.

"I'm not sure we can quite say you should stay in school based on this study alone. But if one looks at the dementia literature, maintaining the health of your brain by being actively involved in your life is important," said study author Eric Schneider, an epidemiologist and assistant professor of surgery at the Johns Hopkins University School of Medicine.

"And in the unlikely event of injury to your brain, it may help," he added.

The study is published online April 23 in the journal Neurology.

About 2.5 million traumatic brain injuries occur each year in the United States and such injuries are among the leading causes of death and disability in children and young adults, according to the U.S. Centers for Disease Control and Prevention. Not all bumps to the head result in a traumatic brain injury, but all of these injuries are caused by a blow, jolt or penetrating injury that upsets normal brain function, the CDC notes.

For the new study, Schneider and his colleagues analyzed 769 patients who had been hospitalized with a moderate to severe traumatic brain injury -- most from motor vehicle accidents or falls -- and later admitted to a rehabilitation facility.

Participants, who were at least 23 years old, were tracked for a minimum of one year after their injury. Grouped by education level, 24 percent had not finished high school; 51 percent had finished high school and some college education; and 25 percent had obtained at least an undergraduate degree, totaling 16 or more years of education.

Researchers found that one year post-injury, participants with some college education were nearly five times more likely to fully recover than those without a high school diploma. Only 10 percent of those who hadn't graduated from high school were free of disability, compared with 31 percent of those with some college education and 39 percent of those with a college degree.

All participants had access to similar-quality health care and rehabilitation after their traumatic brain injury, Schneider said, so results were not compromised by variations in treatment based on education levels.

He acknowledged that it's difficult to prove the cognitive reserve theory or its role in recovery from brain injury and disease, but "it's a fairly well-validated tool."

"We had thought there might be a similar finding in [traumatic brain injury] to what has been demonstrated in other areas where the brain is injured across time. We were pleased to see that the cognitive reserve theory might also be associated with outcomes in acute brain injuries."

Another expert noted that the new study didn't show a cause-and-effect relationship between a person's education level and ability to recover from a traumatic brain injury.

Dr. Howard Derman, a neurologist and co-director of the Methodist Concussion Center in Houston, called the new research "interesting" but said other unexamined factors -- such as patient motivation -- may also account for the discrepancy in recovery between less-educated and more-educated brain injury patients.

"I'm not refuting the observation, I'm just saying that in my mind, [the researchers] can't just say it's because these people are using [more] of their brain before being injured than the others," Derman said. "Cognitive reserve might be one factor, but there are other issues that are ongoing that are equally persuasive as to why those people might do better."

Study author Schneider said future research should focus on the biological mechanisms underlying cognitive reserve and how these processes are associated with education and learning.

"Understanding the biology could help us find ways to encourage brain recovery across the board," he said.

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