The first assessment tool designed to quantify the brain's capacity to absorb and recover from the neurologic stress of surgery and anesthesia — built on 127 verified peer-reviewed references, validated in a 2,062-completer research window.
I built the NSRI™ because the question I kept asking in the OR lacked a measurement tool. Cognitive assessment tools detect existing impairment. What they cannot do is tell a patient or a practitioner what to change before surgery to optimize and protect the brain. That roadmap didn't exist. So I built it.
The NSRI™ is a pre-surgical brain resilience assessment — the core measurement tool of Beyond Brain Health™ and the first instrument designed specifically to quantify neurologic reserve and recovery dynamics before surgical exposure.
The NSRI™ quantifies. It does not diagnose. Its clinical function is to measure the brain's current resilience state, identify modifiable factors that can be strengthened before surgery, and detect historical vulnerability factors that constrain recovery capacity.
V2.5 — the version that closed the research window with 2,062 completers on March 19, 2026.
Formal normality testing confirms the distribution supports parametric statistical tests. 30.1% of a health-engaged, self-selected population already showed quantifiable neurologic vulnerability — standard intake would have cleared all of them.
Domain intercorrelations range from r=0.245 to r=0.39 — moderately positive, confirming the five domains are related but not redundant. Each contributes an independent signal.
The Bottleneck Index™ is a multiplicative modifier (0.00–1.00) derived from 10 history sections. It separates what the brain can optimize from what it permanently carries.
Prior surgical delirium (r=0.727 vs BI) is the single strongest predictor in the entire dataset. Participants with this history have a Bottleneck Index of 0.516, compared with 0.186 in those without — nearly 3× higher. Mean final score: 56.9 (delirium present) vs 70.5 (absent) — a 13.5-point differential. p=5.96×10⁻²³⁵.
This is not a marginal signal. It is a clinical alarm.
The research window cohort consisted of 89.6% females (n=1,847; n=208 males) — representing a clear demographic skew consistent with the populations most affected by connective tissue and autonomic disorders.
Despite different bottleneck profiles by sex, final NSRI™ scores are statistically similar (Mann-Whitney U, p=0.705; Cohen's d=0.056: negligible effect size). The NSRI™ assesses neurologic vulnerability comparably across sexes, even with meaningful demographic and clinical differences. The multi-domain design accounts for these variations.
The NSRI™ does not diagnose cognitive impairment, POCD, postoperative delirium, or any neurologic condition. It does not predict with certainty who will experience cognitive complications. It does not replace clinical evaluation by a licensed healthcare provider.
The four score bands were created using clinical reasoning and data structure. The next step is to formally validate these outcomes by linking pre-surgical NSRI™ scores to postoperative cognitive dysfunction rates and actual recovery patterns through structured follow-up at 2 weeks, 6 weeks, and 3 months.
HARP™ — Holistic Anesthesia Recovery & Preparation — is the clinical application framework built on NSRI™ measurement. It translates findings into a four-step sequence. A framework, not a protocol.
Physician Assistant-Certified and Certified Anesthesiologist Assistant (Anesthetist) — 22 years of clinical experience, 16 years in anesthesia, 10,000+ cases.
After enough cases, the pattern was unmistakable: some patients woke up clear and recovered fast. Others fought for weeks. Same drugs, same procedure, different brains. No one was measuring what made the difference before we started. That is what the NSRI™ was built to address.
Also author of Break Through Anesthesia Fog: Protect Your Brain and Heal Faster After Surgery (April 2026, afteranesthesia.com) and host of ReThink It: The Brain Health & Longevity Podcast.
The NSRI™ quantifies what has never been routinely measured before surgery: the brain's actual capacity to absorb and recover from the neurologic stress of anesthesia.
Key references from this page. Full 127-reference library at beyondbrainhealth.com/nsri-evidence.
