title: Educational history is an independent predictor of cognitive deficits and long-term survival in postacute patients with mild to moderate ischemic stroke.
abstract: OBJECTIVE
  Poststroke cognitive decline and white matter lesions (WML) are related to poor poststroke survival. Whether cognitive reserve as reflected by educational history associates with cognitive decline, recurrent strokes, and poststroke mortality independent of WML is not known.
  
  
  METHODS
  A total of 486 consecutive acute mild/moderate ischemic stroke patients subjected to comprehensive neuropsychological assessment (n=409) and magnetic resonance imaging (n=395) 3 months poststroke were included in the study and followed-up for up to 12 years. Odds ratios (OR) for logistic and hazard ratios for Cox regression analyses are reported (OR and hazard ratio≤1 indicates a beneficial effect).
  
  
  RESULTS
  Long educational history (per tertile) was associated with lower frequency of executive dysfunction in models adjusted for age, sex, marital status, and stroke severity (OR, 0.75; P<0.05) but not when adding WML as a covariate. In contrast, educational history was independently associated with less memory impairment (OR, 0.67; P<0.01), aphasia (OR, 0.69; P<0.05), visuospatial and constructive deficits (OR, 0.70; P<0.05), Mini-Mental State Examination score<25 (OR, 0.53; P<0.0001), and dementia (OR, 0.66; P<0.01). In Cox regression analysis, educational history was not associated with recurrent strokes, but it associated independently with favorable poststroke survival (hazard ratio, 0.86; P<0.05).
  
  
  CONCLUSIONS
  Long educational history associates with less poststroke cognitive deficits, dementia, and favorable long-term survival independent of age, gender, marital status, stroke severity, and WML in patients with mild/moderate ischemic stroke. This supports the hypothesis that educational history as a proxy indicator of cognitive reserve protects against deficits induced by acute stroke.
authors.affiliation: School of Medicine, University of Tampere and Tampere University Hospital, Department of Surgery, Tampere, Finland.
authors.forename: Johanna
authors.initials: J
authors.lastname: Ojala-Oksala
authors.forename: Hanna
authors.initials: H
authors.lastname: Jokinen
authors.forename: Valtteri
authors.initials: V
authors.lastname: Kopsi
authors.forename: Kalevi
authors.initials: K
authors.lastname: Lehtonen
authors.forename: Liisa
authors.initials: L
authors.lastname: Luukkonen
authors.forename: Antti
authors.initials: A
authors.lastname: Paukkunen
authors.forename: Lotte
authors.initials: L
authors.lastname: Seeck
authors.forename: Susanna
authors.initials: S
authors.lastname: Melkas
authors.forename: Tarja
authors.initials: T
authors.lastname: Pohjasvaara
authors.forename: Pekka
authors.initials: P
authors.lastname: Karhunen
authors.forename: Marja
authors.initials: M
authors.lastname: Hietanen
authors.forename: Timo
authors.initials: T
authors.lastname: Erkinjuntti
authors.forename: Niku
authors.initials: N
authors.lastname: Oksala
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000453:epidemiology* / Q000209:etiology*; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D020521:Stroke / Q000150:complications* / Q000401:mortality*