Stroke survivors with higher education levels may experience a faster decline in cognitive function after a stroke, a new study from Michigan Medicine reveals. The research, which analyzed cognitive outcomes in over 2,000 stroke patients from 1971 to 2019, challenges long-held assumptions about the relationship between education and cognitive resilience after a brain injury.
While college graduates initially performed better on cognitive tests—such as memory, attention, and processing speed—compared to those with less education, the study found that individuals with any level of higher education saw a faster decline in executive function. Executive function refers to skills used for daily tasks, such as problem-solving and working memory. These findings were most evident in comparison to patients with less than a high school diploma.
Mellanie V. Springer, M.D., M.S., the study’s lead author and an early career professor of neurology at the University of Michigan Medical School, explained, “Brain atrophy occurs over time regardless of education level. Our findings suggest that higher education may help individuals maintain cognitive function until a certain threshold of brain injury is reached after a stroke. Once this threshold is crossed, the brain’s compensatory mechanisms may fail, leading to rapid cognitive decline.”
For years, researchers have studied education level as a key factor in cognitive reserve—the brain’s ability to cope with and function despite damage. This theory led the team to expect that highly educated individuals would experience slower cognitive decline after a stroke. However, the study’s results, published in JAMA Network Open, suggest otherwise.
Senior author Deborah A. Levine, M.D., M.P.H., a professor at the University of Michigan Medical School, emphasized the significance of the study. “Dementia poses a greater threat after a stroke than having a subsequent stroke,” she noted. “We lack effective treatments to prevent or slow cognitive decline and dementia following a stroke. This research deepens our understanding and generates new hypotheses about the causes of post-stroke cognitive decline and which patients are at higher risk.”
Interestingly, the study also found that genetic factors, such as the presence of the ApoE4 allele—a known risk factor for Alzheimer’s disease—did not alter the relationship between education level and cognitive decline after a stroke. Additionally, the number of strokes a person experienced did not impact the link between education and cognitive decline.
Springer emphasized that this suggests cognitive decline in highly educated stroke patients is not influenced by underlying genetic risk and may occur after just one stroke. “Identifying which stroke patients are most at risk for cognitive decline is crucial for developing future interventions aimed at slowing this decline,” she concluded.
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