A stroke can change a person’s life in many ways—and one serious long-term effect is the loss of mental abilities. New research from Michigan Medicine has found that people who have attended college or received other higher education may experience faster mental decline after a stroke than people with less education.
The study looked at the mental outcomes of more than 2,000 people who had strokes between 1971 and 2019. The researchers focused on how well people performed on tests measuring different parts of thinking, including memory, attention, problem-solving, and processing speed.
At first, people with college-level education did better on these mental tests shortly after their stroke. They showed stronger overall thinking ability, also known as global cognition.
However, over time, those same individuals lost mental skills more quickly than those with less than a high school education—especially in a key area called executive functioning. This includes skills we use for everyday life, such as organizing, planning, and making decisions.
Dr. Mellanie Springer, the lead author of the study and a neurologist at the University of Michigan, explained that the brain naturally shrinks as we age—this is called brain atrophy—and it happens to everyone.
But her team found that highly educated people may have a kind of “mental backup system” that allows them to function well for longer, even if their brain has been damaged. The problem is, once a stroke causes enough harm to the brain, that backup system may stop working. Then, the decline in thinking abilities may happen quickly.
Scientists have long believed that education helps protect the brain by building what they call cognitive reserve—the brain’s ability to handle damage without losing function. Based on this idea, the team originally thought people with more education would decline more slowly after a stroke. But their study, published in JAMA Network Open, showed the opposite.
Dr. Deborah Levine, a senior author of the study, pointed out that dementia—the severe loss of memory and thinking—can be more of a threat after a stroke than having another stroke. Sadly, doctors still don’t have treatments that can stop or slow this mental decline. This research helps shed light on which patients might be more vulnerable, and why.
Interestingly, the study also looked at other factors that could affect how quickly stroke survivors declined. They found that carrying a gene linked to Alzheimer’s disease (called ApoE4) didn’t make a difference.
And having more than one stroke also didn’t change the results. This means that even one stroke might be enough to push highly educated people past a tipping point where their brain can no longer keep up.
Dr. Springer says it’s important to identify which stroke patients are most at risk of mental decline. That way, doctors and researchers can find ways to help them earlier. The hope is that one day, targeted treatments—perhaps medications or personalized therapy—could help slow down or prevent this decline in thinking.
Review and Analysis
This study brings a new and surprising insight into how education affects the brain after a stroke. For years, experts believed that people with more education would be more protected from mental decline because they had a stronger cognitive reserve.
In some ways, that idea still holds true—this study showed that college-educated people had better thinking skills right after their stroke. But it also shows that their decline, once it begins, can be faster.
It’s possible that higher education helps people “mask” the damage for a while. But once the damage becomes too great—like after a stroke—the brain’s ability to cope drops sharply. In contrast, people with lower levels of education might already function closer to their limit, so their decline is slower and more steady.
These findings challenge what we thought we knew and suggest that we should look more closely at individual stroke patients, no matter how educated they are. It reminds us that brain health is complex, and education alone doesn’t always protect us from decline.
Further research will be needed to confirm these findings and figure out how to better care for stroke survivors, especially those at highest risk of losing their mental abilities.
If you care about stroke, please read studies about how to eat to prevent stroke, and diets high in flavonoids could help reduce stroke risk.
For more information about health, please see recent studies about how Mediterranean diet could protect your brain health, and wild blueberries can benefit your heart and brain.
The research findings can be found in JAMA Network Open.
Copyright © 2025 Knowridge Science Report. All rights reserved.
