Bad news for brainiacs.
A new study suggests that highly educated people may suffer greater mental setbacks after a stroke compared to those with less schooling.
“Identifying which stroke patients are at the highest risk for cognitive decline will help target future interventions to slow cognitive decline,” said Dr. Mellanie V. Springer, the lead author of the study and a professor of Neurology at University of Michigan (UM) Medical School.
A stroke strikes when blood flow to the brain is blocked or a blood vessel bursts, spilling blood into the brain.
A third of US adults have at least one of the top stroke risk factors: high blood pressure, high cholesterol, smoking, obesity or diabetes. Age, sex, ethnicity and genetics can also influence your chances, according to the CDC.
Every year, more than 795,000 Americans suffer a stroke — that’s one every 40 seconds. It claims roughly 140,000 lives annually, making up 1 in 20 deaths nationwide, and is a leading cause of disability.
For years, experts have debated whether a higher education level can help the brain stay sharp when it faces challenges such as aging, injury or disease.
In 2022, 104 million Americans aged 25 and older held a bachelor’s degree or higher, only about 37.7% of the US population, according to the Census Bureau.
Springer and her colleagues theorized that more schooling would result in slower cognitive decline after a stroke. But their study, published Wednesday in JAMA Network Open, shattered that assumption.
The research team analyzed the cognitive outcomes of more than 2,000 stroke patients between 1971 and 2019. They found that college graduates performed better on initial post-stroke tests measuring memory, attention and processing speed.
But stroke survivors with any level of higher education saw faster declines in executive functioning — skills like working memory and problem-solving — compared to those with less than a high school diploma.
“Brain atrophy occurs over time regardless of education level,” Springer said.
“Our findings suggest that attending higher education may enable people to retain greater cognitive ability until a critical threshold of brain injury is reached after a stroke. At this point, compensation may fail, and rapid cognitive decline occurs,’ she added.
Decoding dementia risk
Up to 60% of stroke survivors face memory and thinking problems within a year, and a third will develop dementia within five years, according to a statement from the American Stroke Association.
This cognitive decline can impact nearly every part of life — from the ability to work and drive to living independently, as well as thinking, planning, and communicating, according to Dr. Nada El Husseini, chair of the scientific statement writing committee and an associate professor of neurology at Duke University Medical Center.
To better understand the factors that influence a person’s risk for mental setbacks after a stroke, Springer and her team also examined ApoE4 alleles — genetic markers linked to Alzheimer’s disease.
In a surprising twist, they discovered that the number of ApoE4 alleles a stroke survivor carries had no impact on the connection between education level and cognitive decline after the stroke.
Even more unexpectedly, the number of strokes a person had experienced didn’t affect the relationship either.
“We lack treatments that prevent or slow cognitive decline and dementia after stroke,” said Dr. Deborah A. Levine, senior author of the study and a professor of internal medicine and neurology at UM Medical School.
This study increases our understanding and generates potential hypotheses about the causes of post-stroke cognitive decline and which patients face higher risks of it,” she continued.
