This concept emerged as a way to explain variance in loss of cognition
with neurological disorders that produce a generalized
cognitive decline, such as dementia related illness. The idea is that
people with higher IQs have further to fall and hence they have
a greater reserve of cognitive abilities. Higher cognitive function
makes them more resilient to brain illness. They have more
developed cognitive abilities to rely upon when they are injured. It is
an archaic concept that neuropsychologists have largely
abandoned. However, in practice we often quantify the degree of
impairment by a direct reference to an IQ or similar score. The
current practice of estimating pre-injury IQ with demographics and using
this as a metric to quantify the presumed loss in IQ associated
with a brain injury or illness incorporates the cognitive reserve
concept. I can't imagine that anyone believes IQ is an amount of
something that can be lost by monotonic units like water poured from a
pitcher. After stating this, I have done a number of studies that
assumed IQ had this relationship to severity (e.g. Williams, Gomes,
Drudge & Kessler, 1983, Journal of Neurosurgery). I predicted IQ from
initial coma level. There was a significant correlation. This happens
because neuropsych assessment itself is archaic and needs to
develop to the level of neuropsychological theory. Many years ago,
Muriel Lezak actually titled her INS Presidential Address,
"The Death of IQ". She was complaining that this unitary concept was a
poor way to describe cognitive function after a brain illness.
The IQ concept is still alive and kicking, like a zombie. Maybe we need
to give it a clear shot to the head.
Mike Williams
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