The Role of Cognitive Reserve in Post-Stroke Rehabilitation Outcomes: A Systematic Review

 Without telling us what cognitive reserve is and how to acquire it before our stroke, this is useless!

The Role of Cognitive Reserve in Post-Stroke Rehabilitation Outcomes: A Systematic Review 

 ¹,

Donatella Saviola

¹,

Antonio De Tanti

¹ and

Cosimo Costantino

²

¹

Centro Cardinal Ferrari, Via IV Novembre 21, 43012 Fontanellato, Italy

²

Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy

^*

Author to whom correspondence should be addressed.

Brain Sci. 2024, 14(11), 1144; https://doi.org/10.3390/brainsci14111144

Submission received: 9 October 2024 / Revised: 6 November 2024 / Accepted: 13 November 2024 / Published: 15 November 2024

(This article belongs to the Section Neurorehabilitation)

Download keyboard_arrow_down

Browse Figures

Review Reports Versions Notes

Abstract

Background/Objectives: 

Stroke remains a major cause of disability and death, with survivors facing significant physical, cognitive, and emotional challenges. Rehabilitation is crucial for recovery, but outcomes can vary widely. Cognitive reserve (CR) has emerged as a factor influencing these outcomes. This systematic review evaluates the role of CR in post-stroke rehabilitation, examining whether higher CR is associated with better outcomes. 

Methods: 

A systematic search of PubMed, Google Scholar, Scopus, and Cochrane Library databases was conducted for studies published between 2004 and 2024. Studies examining social-behavior CR proxies (e.g., education, bilingualism) and their impact on post-stroke outcomes were included. Data were analyzed using descriptive statistics. The study quality was assessed using the Methodological Index for NOn-Randomized Studies (MINORS) scale. 

Results: 

Among 3851 articles screened, 27 met the inclusion criteria. Higher education levels, bilingualism, and engagement in cognitively stimulating activities were associated with better cognitive outcomes and functional recovery. Lower socioeconomic status (SES) correlated with poorer outcomes. Early rehabilitation and dynamic CR proxies showed stronger associations with cognitive recovery than static ones. 

Conclusions: 

 CR may predict post-stroke rehabilitation outcomes, with education, bilingualism, and active engagement in cognitive activities showing potential benefits. Future research should explore CR’s role alongside factors like lesion location and severity in enhancing recovery.

Keywords:

cognitive reserve; stroke; cognitive outcome; functional outcome; rehabilitation

1. Introduction

Stroke is one of the leading causes of disability and death worldwide, imposing significant individual and societal burdens [1,2,3]. Survivors often face a spectrum of physical, cognitive, and emotional challenges that can severely impact their quality of life [4,5]. Rehabilitation is critical in mitigating these effects, enhancing recovery and maximizing functional independence [6]. However, outcomes can vary widely among individuals, raising the question of what factors contribute to this variability. One emerging concept that has gained considerable attention in recent years in stroke recovery is that of cognitive reserve (CR) [7]. CR represents the brain’s resilience to cope with neurological damage and is believed to be built over a lifetime of intellectual, social, and physical activities [7,8,9].

The notion of CR was first introduced in the context of Alzheimer’s disease, where it was observed that individuals with higher CR could tolerate greater degrees of brain pathology before exhibiting clinical symptoms [10,11]. This concept has since been extended to other neurological conditions, including multiple sclerosis and stroke [7,12,13]. The underlying hypothesis is that a higher CR could provide a protective buffer, enhancing the brain’s ability to compensate for the damage caused by a stroke and improving the efficacy of rehabilitation interventions [14,15].

CR is believed to be shaped by various factors, such as education, occupation, and lifelong engagement in cognitively stimulating activities [9,10,16]. CR is a multifaceted construct, but there are no standardized measurement guidelines to investigate it, with studies frequently relying on indicators, namely socio-behavioral factors (education, occupation, engagement in leisure activities, intelligence indexes, neuropsychological assessment), electrophysiology (EEG/MEG, event-related potentials, functional connectivity), neuroimaging (PET, fMRI, brain size/volume, atrophies, neural activation, functional connectivity), and genetic proxies [8].

Since different studies use various proxies to estimate CR, the effects observed can differ, leading to inconsistent findings [17]. Understanding how cognitive reserve interacts with post-stroke rehabilitation could provide valuable insights into tailoring more effective and individualized therapeutic approaches [18].

This systematic review aims to summarize the current evidence on the role of cognitive reserve. While the body of evidence exploring electrophysiology, neuroimaging, and genetic proxies is growing, there is abundant literature on social–behavioral metrics. Thus, we specifically focused on the relationships between this metric and rehabilitation outcomes in post-stroke subjects. It will examine whether individuals with higher CR show better functional recovery, greater cognitive improvement, and a higher quality of life following stroke rehabilitation. By combining insights from various studies, this review provides a comprehensive understanding of how CR may influence the rehabilitation process.

More at link.