About
The science and the mission
Beyond Brain Health exists because surgical patients deserve objective neurologic data before they go under anesthesia - and a clear picture of recovery on the other side.
Sandra Bargeron, PA-C, CAA
Physician Assistant-Certified | Certified Anesthesia Assistant
Sande has spent over two decades working in surgical and anesthesia settings. Throughout her career she noticed a consistent gap: patients were arriving for surgery without any structured assessment of their neurologic baseline. The outcome data existed in silos. Nobody was connecting the dots.
She developed the Neurologic Stress and Recovery Index to fill that gap. The NSRI is not a diagnostic test - it is a structured, evidence-informed assessment of the factors that determine how the brain handles the stress of surgery and anesthesia. Think of it as a stress test: not to find disease, but to measure capacity.
The Post-Surgical NSRI (PSNRI) extends the picture into recovery - tracking five cognitive and functional constructs from 24 hours post-op through six months, giving patients and their providers a clear trajectory.
The science behind the instruments
NSRI: 5 domains of neurologic reserve
The NSRI measures cardiometabolic health, medication and pain burden, sleep and circadian health, lifestyle factors, and brain and social reserve. Each domain has its own scoring track; they combine into a final score through a defined formula that includes a Bottleneck Index and interaction penalties for co-occurring risk factors.
Bottleneck Index
Some risk factors compound each other. The Bottleneck Index captures this: a patient with poor sleep, high medication burden, and a history of neuroinflammatory infection does not simply sum to three risks. The BI applies a multiplier that reflects how these factors interact under surgical stress.
PSNRI: 5 areas, before and after surgery
The Post-Surgical Neurologic Recovery Index tracks processing and attention, memory, executive function, sleep, and daily function. You answer once before surgery and again at Day 7, Day 30, 3 months, and 6 months (optionally 12). Change relative to your own baseline is the primary metric - not the absolute number, but the trajectory.
No diagnosis, no algorithm
The NSRI and PSNRI are assessment tools. They do not diagnose post-surgical cognitive changes, dementia, or any other condition. They give a structured, data-based starting point for clinical conversations. Your surgeon and anesthesiologist remain the decision-makers. This tool helps them make better-informed ones.
The mission
Every surgical patient should know their neurologic reserve before they go under anesthesia. Not as a scare tactic - as a starting point. A number that says: here is your brain right now, here are the areas to strengthen, here is what to watch for. A baseline that makes recovery meaningful because you know where you started.
Beyond Brain Health makes this assessment available to anyone planning surgery, regardless of whether their surgical team has ordered it. You do not need a referral. You need 20 minutes and the willingness to know.
Start your assessment