| Title: |
Education levels and poststroke cognitive trajectories |
| Authors: |
Springer, MV; Whitney, RT; Ye, W; Briceño, EM; Gross, AL; Aparicio, HJ; Beiser, AS; Burke, JF; Elkind, MSV; Ferber, RA; Giordani, B; Gottesman, RF; Hayward, RA; Howard, VJ; Kollipara, AS; Koton, S; Lazar, RM; Longstreth, WT; Pendlebury, ST; Sussman, JB; Thacker, EL; Levine, DA |
| Publisher Information: |
American Medical Association |
| Publication Year: |
2026 |
| Collection: |
Oxford University Research Archive (ORA) |
| Description: |
Importance: Acute stroke is associated with accelerated, years-long cognitive decline. Whether education levels are associated with faster cognitive decline after stroke is unclear. Objective: To evaluate the association of education level with poststroke cognitive decline and to determine whether age at stroke modifies the association. Design, Setting, and Participants: Individual participant data meta-analysis of 4 US cohort studies (January 1971 to December 2019). Analysis began August 2022 and was completed in January 2024. Exposures: Education level (less than high school, completed high school, some college, and college graduate). Main Outcomes and Measures: Harmonized cognitive outcomes were global cognition (primary outcome), memory, and executive function. Outcomes were standardized as t scores (mean [SD], 50 [10]); a 1-point difference represents a 0.1-SD difference in cognition, with higher score representing better function. Linear mixed-effect models estimated the trajectory of cognitive decline after incident stroke. Results: The analysis included 2019 initially dementia-free stroke survivors (1048 female [51.9%]; median [IQR] age at stroke, 74.8 [69.0-80.4] years; 339 with less than a high school education [16.7%]; 613 who completed high school [30.4%]; 484 with some college [24.0%]; 583 with a college degree or higher [28.9%]). Median (IQR) follow-up time after stroke was 4.1 (1.8-7.2) years. Compared with those with less than a high school degree, college graduates had higher initial poststroke performance in global cognition (1.09 points higher; 95% CI, 0.02 to 2.17 points higher), executive function (1.81 points higher; 95%CI, 0.38 to 3.24 points higher), and memory (0.99 points higher; 95% CI, 0.02 to 1.96 points higher). Compared with stroke survivors with less than a high school education, there was a faster decline in executive function among college graduates (−0.44 points/y faster; 95% CI, −0.69 to −0.18 points/y faster) and those with some college education(−0.30 points/y faster; 95% ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
https://doi.org/10.1001/jamanetworkopen.2025.2002 |
| DOI: |
10.1001/jamanetworkopen.2025.2002 |
| Availability: |
https://doi.org/10.1001/jamanetworkopen.2025.2002; https://ora.ox.ac.uk/objects/uuid:e39fcda6-ee0f-4f35-b570-c8025b88e6f0 |
| Rights: |
info:eu-repo/semantics/openAccess ; CC Attribution (CC BY) |
| Accession Number: |
edsbas.86DE37FB |
| Database: |
BASE |