Purpose: Cognitive reserve and neuropsychological test results are linked to outcomes after acquired brain injury (ABI), but their interaction and their impact on different types of outcomes remains to be explored. This study aimed to explore how cognitive reserve, measured by education, is related to neuropsychological outcomes, return-to-work and life satisfaction after ABI.

Methods: Long term follow-up of 83 patients with ABI, 5-15 years after specialized brain injury rehabilitation. Logistic regression was used to analyze the relationship between independent variables and outcomes (return-to-work and life satisfaction).

Results: Return-to-work was associated with cognitive reserve (OR = 1.31, p = 0.024), age (OR = 0.95, p = 0.042), general fatigue (OR = 0.77, p = 0.034), and Cognitive Profiency Index (measures of working memory and processing speed, OR = 1.06, p = 0.037). Verbal and spatial abilities were related to education, but not to return-to-work. General fatigue was related to satisfaction with mental health in both univariate (OR = 0.78, p = 0.008) and multivariate analyses (OR = 0.8, p = 0.037), but no other variables were significantly associated with life satisfaction in multivariate analyses.

Conclusion: Patients with lower cognitive reserve paired with slower processing speed and poor working memory may need additional support for successful return-to-work, while life satisfaction appears to depend more on other factors.