A new study from Michigan Medicine suggests that stroke survivors with higher levels of education may experience faster mental decline after their stroke, despite showing stronger thinking abilities early on.
Researchers looked at over 2,000 patients who had a stroke between 1971 and 2019. They found that people who went to college did better on their first cognitive tests after their stroke. These tests measured overall thinking skills like memory, attention, and how quickly someone can process informat…
But over time, people with higher education levels showed faster decline in executive function. These are the brain skills we use to manage daily tasks—like remembering appointments, staying focused, and solving problems. People with less than a high school education didn’t experience this same rapid drop in executive function.
Dr. Mellanie V. Springer, the lead author of the study and a professor of neurology at the University of Michigan, explained that the brain naturally shrinks with age no matter how much education someone has.
She said their findings suggest that higher education may help people keep better mental function after a stroke—at least at first. But once their brain passes a certain level of injury, the ability to “compensate” and stay sharp can suddenly fail, causing faster decline.
For many years, scientists believed that people with more education had better “cognitive reserve,” meaning they could handle brain damage better and keep functioning well. This made the researchers think that more education would protect people from mental decline after a stroke. However, their results showed the opposite.
Dr. Deborah A. Levine, a senior author of the study and a professor of internal medicine and neurology at the University of Michigan, said the risk of developing dementia after a stroke is greater than the risk of having another stroke.
Unfortunately, there are still no treatments that can stop or slow down mental decline and dementia after a stroke. This study helps researchers understand more about which stroke survivors are most at risk for memory loss and why.
The researchers also looked at whether a person’s genes or the number of strokes they had would affect their results. They studied a gene called ApoE4, which raises the risk for Alzheimer’s disease.
They found that this gene did not change the link between education level and mental decline after stroke. Similarly, having more than one stroke didn’t make a difference either.
This means that highly educated stroke survivors may reach a point of brain damage where their brains can no longer compensate, and that point can come even after just one stroke. Dr. Springer believes that understanding who is most at risk can help doctors target treatments or support systems to the people who need them most.
The study was supported by funding from the National Institute on Aging and the National Institute of Neurological Disorders and Stroke. Researchers from various departments at the University of Michigan took part in the study.
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