Health Sciences Institute, Portuguese Catholic University, Lisbon, Portugal.
Centre for Interdisciplinary Research in Health, Lisbon, Portugal.
J Clin Exp Neuropsychol. 2021 Nov;43(9):839-860. doi: 10.1080/13803395.2021.2014788. Epub 2022 Jan 11.
Cognitive Reserve (CR) hypothesis was introduced to account for the variability in cognitive performance of patients with similar degrees of brain injury or pathology. The individual variability of CR is modulated by the interaction of innate capacities and exposures throughout life, which can act as protectors against neuropathology's clinical effects. Individuals with higher CR appear to have better cognitive performance after a brain injury. The present review aimed to identify and map the scientific evidence available in literature regarding CR's influence in protecting the cognitive status after an Acquired Brain Injury (ABI).
A systematic review was performed for published studies until October 2020 in PubMed, Scopus, and CINAHL electronic databases. Studies regarding CR's influence in protecting the cognitive status after an ABI were included in this review. The Newcastle-Ottawa Scale was used to assess risk of bias in the included studies. This systematic review was recorded in the International Prospective Register of Systematic Reviews (PROSPERO) under the number CRD42021236594.
Twenty-one studies published between 2003 and 2020 were selected and analyzed. The literature analysis showed that CR has a positive effect on cognitive status after an ABI. Various proxies were used to estimate CR, including estimated premorbid IQ, education, occupation attainment, socioeconomic status, leisure activities, bilingualism, and social integration. CR proxies constitute a set of variables that may have a significant influence on cognitive status. Higher CR levels were associated with lower cognitive impairment after an ABI.
Although more research is necessary for a complete understanding of CR's impact on cognition, the synthesis of these studies confirmed that there is evidence on the beneficial impact of CR on cognitive status after an ABI. These findings support CR's cognitive status role following an ABI and may provide additional information for prognosis and rehabilitation plans.
认知储备（CR）假说的提出是为了解释具有相似程度脑损伤或病理的患者认知表现的可变性。CR 的个体可变性受个体一生中内在能力和暴露因素相互作用的调节，这些因素可以作为对抗神经病理学临床影响的保护因素。具有较高 CR 的个体在脑损伤后似乎具有更好的认知表现。本综述旨在确定并绘制文献中关于 CR 对保护获得性脑损伤（ABI）后认知状态的影响的现有科学证据。
对 PubMed、Scopus 和 CINAHL 电子数据库中截至 2020 年 10 月发表的研究进行了系统评价。本综述纳入了关于 CR 对 ABI 后认知状态的保护作用的研究。采用纽卡斯尔-渥太华量表（Newcastle-Ottawa Scale）评估纳入研究的偏倚风险。本系统评价已在国际前瞻性系统评价登记处（PROSPERO）记录，注册号为 CRD42021236594。
共选择并分析了 2003 年至 2020 年发表的 21 项研究。文献分析表明，CR 对 ABI 后认知状态有积极影响。各种指标被用于估计 CR，包括预估的发病前智商、教育、职业成就、社会经济地位、休闲活动、双语和社会融合。CR 指标构成了一组可能对认知状态有重大影响的变量。CR 水平较高与 ABI 后认知障碍程度较低相关。
尽管需要更多的研究才能全面了解 CR 对认知的影响，但这些研究的综合分析证实了 CR 对 ABI 后认知状态有有益影响的证据。这些发现支持了 CR 在 ABI 后对认知状态的作用，并为预后和康复计划提供了额外的信息。
