• Kayla A Steward, Richard Kennedy, Thomas A Novack, Michael Crowe, Daniel C Marson, and Kristen L Triebel.
• Department of Psychology (Ms Steward and Dr Crowe), Department of Medicine (Dr Kennedy), Department of Physical Medicine and Rehabilitation (Dr Novack), and Department of Neurology (Drs Marson and Triebel), University of Alabama at Birmingham.
• J Head Trauma Rehabil. 2018 Jan 1; 33 (1): E18-E27.

ObjectiveTo examine whether cognitive reserve (CR) attenuates the initial impact of traumatic brain injury (TBI) on cognitive performance (neural reserve) and results in faster cognitive recovery rates in the first year postinjury (neural compensation), and whether the advantage of CR differs on the basis of the severity of TBI.SettingInpatient/outpatient clinics at an academic medical center.ParticipantsAdults with mild TBI (mTBI; n = 28), complicated mild TBI (cmTBI; n = 24), and moderate to severe TBI (msevTBI; n = 57), and demographically matched controls (n = 66).DesignRetrospective, longitudinal cohort assessed at 1, 6, and 12 months postinjury.Main MeasuresOutcomes were 3 cognitive domains: processing speed/executive function, verbal fluency, and memory. Premorbid IQ, estimated with the Wechsler Test of Adult Reading, served as CR proxy.ResultsHigher premorbid IQ was associated with better performance on cognitive domains at 1 month postinjury, and the effect of IQ was similarly beneficial for all groups. Cognitive recovery rate was moderated only by TBI severity; those with more severe TBI had faster recovery in the first year.ConclusionResults support only the neural reserve theory of CR within a TBI population and indicate that CR is neuroprotective, regardless of the degree of TBI. Higher premorbid CR does not allow for more rapid adaptation and recovery from injury.

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