Every year, millions of people go into surgery having no idea what state their brain is actually in. Standard pre-op screening checks your heart, your lungs, your blood. Nobody checks whether your brain has the reserve to handle the stress of anesthesia — and recover from it.
That gap is what the NSRI™ was built to close. It measures the modifiable factors that determine whether your brain emerges from surgery thinking clearly — or struggling for weeks, months, or longer.
We don’t predict who will decline. We identify what can be strengthened.
Surgery doesn’t create vulnerabilities. It reveals them.
Anesthesia is a neurologic stress event. Outcomes depend on the brain’s pre-existing resilience — not just drug choice. The NSRI™ measures that resilience before the procedure, while there’s still time to strengthen it.
Five Domains. One Score. A Clear Picture.
The NSRI™ scores your neurologic reserve across five modifiable domains — areas where small changes before surgery can meaningfully improve what happens after.
Cardiometabolic Health
Blood pressure, blood sugar, cholesterol, and weight all directly feed into neurologic resilience. Your cardiovascular and metabolic system determines how your brain handles surgical stress.
Why it matters: Uncontrolled metabolic factors are among the most modifiable brain risks before surgery.Medication & Pain Burden
Common sleep aids, allergy drugs, and anxiety medications place real load on the brain. Chronic pain does too. This domain maps your current pharmacologic and pain burden.
Why it matters: 1 in 4 people carry unrecognized anticholinergic drug burden that affects brain recovery.Sleep & Circadian Health
Sleep is the brain’s primary recovery system. Your sleep quality, duration, and circadian rhythm integrity determine how much reserve the brain has going into surgery.
Why it matters: Only 9.4% of NSRI™ completers report truly restorative sleep. It’s the most depleted domain we see.Lifestyle
Exercise frequency, hydration, nutritional status, and daily activity patterns shape the brain’s capacity to handle and recover from neurologic stress. The most actionable domain before surgery.
Why it matters: 38% of completers rarely or never exercise. Nearly half are sedentary going into a procedure.Brain & Social Health
Cognitive engagement, social connection, mental health, and hearing health are measurable brain reserve factors. How active your brain stays between now and surgery directly affects how well it recovers after.
Why it matters: Social isolation and untreated hearing loss are among the top 3 modifiable dementia risk factors.Simple to Take. Clinically Meaningful.
The NSRI™ takes 15–20 minutes. No lab work. No clinic visit. Just honest answers about where you are right now.
Work through five scored domains and eleven history sections. Questions are straightforward — no medical jargon. You’ll recognize everything you’re asked.
15–20 minutesYour NSRI™ report breaks down your score across all five domains, calculates your Bottleneck Index™, and identifies your specific modifiable opportunities — ranked by impact.
Delivered immediatelyYour report includes specific, actionable next steps organized by domain. You’ll know exactly where your brain is strongest, where it’s most depleted, and what to address first.
Your NSRI™ report is designed to be shared with your surgeon, anesthesiologist, or integrative practitioner. It gives your care team information that standard pre-op screening doesn’t capture.
Anyone Who Will Ever Have Surgery
The NSRI™ was designed for the general pre-surgical population — not just high-risk patients. Because the data shows most people don’t know their risk until after surgery reveals it.
Data from 869+ NSRI™ completers · March 2026 · Full evidence base →
Your ReportWhat You’ll Receive
Your NSRI™ report is not a list of things wrong with you. It’s a map of what can be strengthened — with specific guidance tied to your actual results.
What the NSRI™ Is — and Isn’t
There’s a lot of brain health content out there. The NSRI™ is a specific clinical tool with a specific purpose.
- A prediction of cognitive decline
- A diagnosis of any condition
- A replacement for your doctor or care team
- A supplement or product recommendation tool
- A psychological or emotional wellness assessment
- A substitute for standard preoperative medical evaluation
- A validated measurement of your current neurologic reserve
- A pre-stressor optimization tool — built to be used before surgery
- A map of your most modifiable brain resilience factors
- A clinical-grade baseline grounded in 75+ peer-reviewed references
- Built by a Certified Anesthesiologist Assistant from inside the OR
- The first assessment of its kind for perioperative brain health
Your brain is going into surgery.
Do you know what state it’s in?
The NSRI™ takes 15–20 minutes. The free research window is open now. Results delivered immediately.
Take the Free NSRI™ Assessment Want to see the research first? View the complete evidence base →Questions People Ask Before Taking the NSRI™
Plain answers, no filler.
What is the Neurologic Stress & Recovery Index™?
The NSRI™ is the first validated pre-surgical assessment tool designed to measure the brain’s capacity to absorb and recover from neurologic stressors — including anesthesia and surgery. Think of it as a stress test for your brain. It scores your neurologic reserve across five modifiable domains and calculates a Bottleneck Index™ based on historical vulnerability factors. Developed by Sandra Bargeron, PA-C, CAA, a Certified Anesthesiologist Assistant with 22 years of clinical experience.
Is there a brain stress test before surgery?
Yes — the NSRI™ is specifically designed as a pre-surgical brain stress test. Standard preoperative screening checks your heart, lungs, and blood. It doesn’t measure whether your brain has the reserve to handle the neurologic stress of anesthesia and recover from it. The NSRI™ fills that gap. It’s available free at beyondbrainhealth.com during the current research window.
What causes brain fog after surgery or anesthesia?
Post-surgical brain fog — clinically called Postoperative Cognitive Dysfunction (POCD) or Delayed Neurocognitive Recovery — occurs when the brain lacks sufficient reserve to handle the neurologic stress of anesthesia and surgery. Key risk factors include poor sleep quality, sedentary lifestyle, high medication burden, uncontrolled metabolic conditions, prior head injuries, and family history of dementia. The NSRI™ measures all of these before surgery so they can be addressed while there’s still time to act.
How do I prepare my brain for surgery?
Brain preparation before surgery focuses on five modifiable areas: cardiometabolic health, medication burden, sleep quality, lifestyle factors, and brain and social health. The NSRI™ identifies which of these areas is most depleted for you specifically — so you know exactly where to focus the time you have before your procedure.
What is postoperative cognitive dysfunction (POCD)?
Postoperative cognitive dysfunction (POCD) — now formally termed Delayed Neurocognitive Recovery per the 2018 Evered nomenclature consensus — is a measurable decline in cognitive function following surgery and anesthesia. It affects an estimated 10–23% of older surgical patients at one month post-surgery. Risk factors are modifiable and can be identified before surgery. Standard preoperative screening does not currently assess for POCD risk — which is the gap the NSRI™ was built to close.
What is the Bottleneck Index™?
The Bottleneck Index™ measures how historical factors — prior head injuries, previous surgical delirium, family history of dementia, prior anesthesia reactions, and cumulative anesthesia exposure — constrain the brain’s recovery capacity. It’s applied as a multiplicative penalty to the base NSRI™ score. 98.4% of completers carry at least one Bottleneck factor. Most had no idea.
Who built the NSRI™ and why?
The NSRI™ was developed by Sandra Bargeron, PA-C, CAA — a Certified Anesthesiologist Assistant with 22 years of clinical experience and 10,000+ anesthesia cases. After 16 years at the head of the operating table, she recognized a consistent gap: medicine was measuring everything about the body before surgery except the brain’s actual capacity to handle neurologic stress. She built the NSRI™ to close that gap — from inside the specialty, not outside it.
How long does it take and what do I get?
The NSRI™ takes 15–20 minutes. No lab work or clinic visit required. Your personalized report is delivered immediately and includes your overall NSRI™ score, a domain-by-domain breakdown, your Bottleneck Index™, ranked modifiable priority areas, care team language, and specific next-step recommendations matched to your results.
Is the NSRI™ backed by research?
Yes. The NSRI™ is supported by 75+ peer-reviewed references spanning all five scored domains. Key foundational studies include the Lancet Commissions on Dementia (2017, 2020, 2024), Evered et al. 2018, Inouye et al. 2014, and Gray et al. 2015. The complete verified reference library is available at beyondbrainhealth.com/nsri-evidence.
Does the NSRI™ replace my pre-op appointment?
No. The NSRI™ is not a replacement for standard preoperative medical evaluation or your care team’s clinical judgment. It is a complementary tool that measures neurologic reserve factors that standard pre-op screening doesn’t address. Think of it as information you bring to your pre-op appointment — not a substitute for it.