Past Life Experiences and Neurological Recovery: The Role of Cognitive Reserve in the Rehabilitation of Severe Post-Anoxic Encephalopathy and Traumatic Brain Injury

Objective:Patients with an equivalent clinical background may show unexpected interindividual differences in theiroutcome. The cognitive reserve (CR) model has been proposed to account for such discrepancies, but its role afteracquired severe injuries is still being debated. We hypothesize that inappropriate investigative methods might have beenused when dealing with severe patients, which have very likely reduced the possibility of observing meaningfulinfluences in recovery from severe traumas.Methods:To overcome this issue, the potential neuroprotective role ofCR was investigated, considering a wider spectrum of clinical symptoms ranging from low-level brain stem functionsnecessary for life to more complex motor and cognitive skills. In the present study, data from 50 severe patients, 20suffering from post-anoxic encephalopathy (PAE) and 30 with traumatic brain injury (TBI), were collected andretrospectively analyzed.Results:We found that CR, diagnosis, time of hospitalization, and their interaction had aneffect on the clinical indexes. When the predictive power of CR was investigated by means of two machine learningclassifier algorithms, CR, together with age, emerged as the strongest factor in discriminating between patients whoreached or did not reach successful recovery.Conclusions:Overall, the present study highlights a possible role of CRin shaping the recovery of severe patients suffering from either PAE or TBI. The practical implications underlying theneed to routinely considered CR in the clinical practice are discussed.