Premorbid intellectual functioning, education, and brain size in traumatic brain injury: an investigation of the cognitive reserve hypothesis

Appl Neuropsychol. 2003;10(3):153-62. doi: 10.1207/S15324826AN1003_04.


Cognitive reserve theories have been postulated in an attempt to explain individual differences in functional outcome following cerebral insult or disease. These theories suggest that higher education and psychometric intelligence may preserve functional capacity regardless of injury or disease severity. This study investigated cognitive reserve in 25 participants with traumatic brain injury (TBI) using high-resolution magnetic resonance imaging (MRI) analyses. We examined the relationships between total intracranial volume (TICV), ventricle-tobrain ratio (VBR), education level, and standardized testing obtained prior to injury with post-injury cognitive outcome. Participants with lower post-injury IQ scores had significantly lower TICV values, irrespective of injury severity, and experienced significantly greater change in IQ from pre- to post-injury. TICV and education correctly predicted participants' post-injury IQ category ( Y 90 or < 90). However, premorbid standardized testing (PST) scores did not predict cognitive outcome. The results of this study suggest that larger premorbid brain volume and higher education level may decrease vulnerability to cognitive deficits following TBI, consistent with the notion of a cognitive reserve.

MeSH terms

  • Adult
  • Brain / pathology
  • Brain Injuries / complications*
  • Brain Injuries / diagnosis
  • Cognition Disorders / diagnosis*
  • Cognition Disorders / etiology*
  • Educational Status
  • Female
  • Glasgow Coma Scale
  • Humans
  • Intelligence*
  • Magnetic Resonance Imaging
  • Male
  • Psychological Theory*