Journal of the International Neuropsychological Society


What is cognitive reserve? Theory and research application of the reserve concept

a1 Cognitive Neuroscience Division, G.H. Sergievsky Center, The Taub Institute, and Departments of Neurology, Psychiatry, and Psychology, Columbia University College of Physicians and Surgeons


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. (JINS, 2002, 8, 448–460.)

(Received August 22 2000)
(Revised February 26 2001)
(Accepted February 28 2001)

Key Words: Functional imaging; Alzheimer's disease; Compensation; Brain damage; Epidemiology.

c1 Reprint requests to: Yaakov Stern, Sergievsky Center, 630 W. 168th Street, New York, NY 10032. E-mail: