Study Finds Faster Mental Decline in Highly Educated Stroke Survivors - Video

When someone has a stroke, it can accelerate the loss of cognitive ability over the coming years. Stroke survivors who have attended some level of higher education may face even steeper mental declines, according to a study led by Michigan Medicine.

In an analysis of cognitive outcomes for more than 2,000 patients seen for stroke between 1971 and 2019, college graduates performed better on initial post-stroke examinations of global cognition, a measure of overall cognitive ability that includes mental functions like memory, attention and processing speed.

However, stroke survivors who attended any level of higher education had faster declines in executive functioning — skills used to manage everyday tasks, such as working memory and problem solving — compared to patients with less than a high school degree.

For years, researchers have considered education level as a predictor of cognitive reserve, the ability to preserve higher levels of functioning despite brain injury that occurs throughout life. This led the researchers to hypothesize that highly educated people would have a slower cognitive decline after a stroke.

However, the results, published in JAMA Network Open, reflect the opposite. Having a higher number of the ApoE4 allele, a genetic risk factor for Alzheimer's disease, did not affect the association between education level and cognitive decline after stroke. The number of strokes a person suffered also did not affect the relationship.

This means that the critical point of brain injury at which cognitive compensation fails in the highly educated does not depend on underlying genetic risk and can be reached after a single stroke.

Hence, they concluded that identifying which stroke patients are at the highest risk for cognitive decline will help target future interventions to slow cognitive decline.