AUTHOR=Hakiki Bahia , Pancani Silvia , Romoli Anna Maria , Draghi Francesca , Maccanti Daniela , Mannini Andrea , Cecchi Francesca 

TITLE=Cognitive reserve index and long-term disability in patients with severe traumatic brain injury discharged from the intensive rehabilitation unit

JOURNAL=Frontiers in Neurology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1106989

DOI=10.3389/fneur.2023.1106989

ISSN=1664-2295

ABSTRACT=Objectives: The “cognitive reserve” (CR) theory posits that higher premorbid cognitive activities can mitigate the effects of brain damage. This study aimed to investigate the association between CR and long-term functional autonomy in patients surviving a severe traumatic brain injury (sTBI). 
Setting: Data were collected from the database of inpatients Severe Acquired Brain Injury Rehabili-tation Unit admitted from August 2012 to May 2020.
Participants: Patients that had incurred an sTBI, aged 18+ years, completing the phone Glasgow Outcome Scale-Expanded at follow-up (pGOS-E) in absence of previous brain trauma or neurologi-cal disease, or cognitive disorders were included. Patients with severe brain injury from non-traumatic etiologies were not included in the study.
Design: In this longitudinal study, all patients underwent a multidimensional assessment including the cognitive reserve index questionnaire (CRIq), the coma recovery scale-revised, the level of cog-nitive functioning, the Disability Rating Scale (DRS), the Galveston Orientation and Amnesia Test at admission. At discharge, functional scales were administered again together with the Glasgow Outcome Scale.  The pGOS-E was assessed at follow-up.
Main Measures: pGOS-E 
Results: One hundred and six patients/caregivers underwent the pGOS-E after 5.8 [3.6] years from the event. Forty-six (43.4%) died after discharge. Sixty patients (Men: 48 (80%); median age: 54 years; median time post-onset: 37 days; median education level: 10 years; median CRIq total score: 91) were included in the analysis exploring the association between pGOS-E and demographic data, cognitive reserve surrogates, and clinical variables at admission and discharge from the rehabilitation unit. A younger age (B= -0.035, p= 0.004) and a lower DRS category at discharge (B -0.392, p=0.029) were significantly related to a higher long-term functional autonomy in the multivariate analysis.
Conclusion: Long-term functional autonomy was not influenced by CR as assessed through the ed-ucational level and the CRIq.