Association between early cognitive rehabilitation and long-term cognitive recovery in patients with mild traumatic brain injury: a retrospective cohort study.

Objective: To examine the association between early cognitive rehabilitation (E-CR) and long-term cognitive, functional, and biomarker outcomes in patients with mild traumatic brain injury (mTBI). Methods: This single-center retrospective cohort study included 185 patients with mTBI who completed at least 12 months of follow-up. E-CR was defined as at least three cognitive rehabilitation sessions within 30 days after injury, whereas patients without rehabilitation within 30 days or with rehabilitation initiated after 30 days were classified as the Non-early-CR group. Cognitive outcomes were assessed using MoCA scores at 6 and 12 months, and functional outcomes included ADL, GOS-E, and return to work or study. Serum NfL, GFAP, and IL-6 were longitudinally analyzed as exploratory biomarkers. Results: Among 185 patients, 91 were included in the E-CR group and 94 in the Non-early-CR group. Baseline characteristics were comparable between groups. At 12 months, the E-CR group showed greater MoCA improvement than the Non-early-CR group (ΔMoCA: 7.03 vs. 3.01, Conclusion: E-CR was associated with better long-term cognitive and functional outcomes and with more favorable exploratory biomarker trajectories in patients with mTBI. Prospective studies are needed to confirm causality and clarify underlying mechanisms.