Stern Yaakov
G.H. Sergievsky Center, The Taub Institute, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
J Int Neuropsychol Soc. 2002 Mar;8(3):448-60.
The idea of reserve against brain damage stems from the repeated observation that there does not appear to be a direct relationship between the degree of brain pathology or brain damage and the clinical manifestation of that damage. This paper attempts to develop a coherent theoretical account of reserve. One convenient subdivision of reserve models revolves around whether they envision reserve as a passive process, such as in brain reserve or threshold, or see the brain as actively attempting to cope with or compensate for pathology, as in cognitive reserve. Cognitive reserve may be based on more efficient utilization of brain networks or of enhanced ability to recruit alternate brain networks as needed. A distinction is suggested between reserve, the ability to optimize or maximize normal performance, and compensation, an attempt to maximize performance in the face of brain damage by using brain structures or networks not engaged when the brain is not damaged. Epidemiologic and imaging data that help to develop and support the concept of reserve are presented.
脑病理学或脑损伤的程度与该损伤的临床表现之间似乎不存在直接关系。本文试图对储备进行连贯的理论阐述。储备模型的一种便利细分围绕着它们是否将储备设想为一个被动过程，比如脑储备或阈值，或者将大脑视为积极尝试应对或补偿病理学情况，比如认知储备。认知储备可能基于对脑网络更高效的利用，或者基于根据需要招募备用脑网络的能力增强。有人提出应区分储备（即优化或最大化正常表现的能力）和代偿（即通过使用大脑未受损时未参与的脑结构或网络来在脑损伤情况下最大化表现的尝试）。文中还呈现了有助于发展和支持储备概念的流行病学及影像学数据。
