Does cognitive reserve predict 3-month functional outcome in neurocritical care?
Race JN, Griffiths S, Wheelwright D, Gordon E, Bederson J, Mayer SA, and Dangayach NS. Does cognitive reserve predict 3-month functional outcome in neurocritical care? Neurocritical Care 2017; 27(2):S209.
Introduction The Cognitive Reserve Hypothesis refers to inter-individual differences in the ability of patients to cope with brain pathology. Cognitive reserve can be measured by surrogate markers such as education and occupation and has shown to be an important predictor of outcomes in Alzheimer disease, multiple sclerosis and traumatic brain injury. In this prospective longitudinal cohort study we determined whether cognitive reserve measured as number of years of education and employment status predicted 3-month functional outcome of NCC patients. Methods We included patients with an expected length of stay of > 48 hours in the neurocritical care unit. Demographic and clinical data, including number of years of education and occupational status, were collected. At three months after discharge, Glasgow Outcome Scales (GOS) were collected via telephone from patients or surrogate respondents. GOS scores were categorized into 'Good' (GOS 4-5) or 'Poor' outcome (GOS 1-3). Results From March 2016 to July 2016, 35/83 patients with 3-month follow-up data were included. Mean age was 56 ± 19 years, 12 (34%) were male, with stroke as the predominant admitting diagnosis. The two groups with good vs poor outcomes did not differ in age, gender or race in univariate analysis although employment status was statistically different in the two groups. In multivariate logistic regression neither employment nor education was a significant predictor of good vs poor outcome (P = 0.34, P = 0.88). Conclusions Prognostication in neurocritical care patients is difficult. The effect of cognitive reserve needs to be studied further. Our current sample size is small and as enrollment continues, we will determine the relationship between cognitive reserve and 3-month functional outcome.