title: Higher Education Is Associated with a Lower Risk of Dementia after a Stroke or TIA. The Rotterdam Study.
abstract: BACKGROUND
  Higher education is associated with a lower risk of dementia, possibly because of a higher tolerance to subclinical neurodegenerative pathology. Whether higher education also protects against dementia after clinical stroke or transient ischemic attack (TIA) remains unknown.
  
  
  METHODS
  Within the population-based Rotterdam Study, 12,561 participants free of stroke, TIA and dementia were followed for occurrence of stroke, TIA and dementia. Across the levels of education, associations of incident stroke or TIA with subsequent development of dementia and differences in cognitive decline following stroke or TIA were investigated.
  
  
  RESULTS
  During 124,862 person-years, 1,463 persons suffered a stroke or TIA, 1,158 persons developed dementia, of whom 186 developed dementia after stroke or TIA. Risk of dementia after a stroke or TIA, compared to no stroke or TIA, was highest in the low education category (hazards ratio [HR] 1.46, 95% CI 1.18-1.81) followed by intermediate education category (HR 1.36, 95% CI 1.03-1.81). No significant association was observed in the high education category (HR 0.62, 95% CI 0.25-1.54). In gender stratified analyses, decrease in risk of dementia with increasing education was significant only in men.
  
  
  CONCLUSIONS
  Higher education is associated with a lower risk of dementia after stroke or TIA, particularly in men, which might be explained by a higher cognitive reserve.
authors.affiliation: Department of Epidemiology, Erasmus MC - University Medical Center, Rotterdam, The Netherlands.
authors.forename: Saira Saeed
authors.initials: SS
authors.lastname: Mirza
authors.forename: Marileen L P
authors.initials: ML
authors.lastname: Portegies
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Wolters
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Koudstaal
authors.forename: Henning
authors.initials: H
authors.lastname: Tiemeier
authors.forename: M Arfan
authors.initials: MA
authors.lastname: Ikram
mesh_terms: D000368:Aged; D003704:Dementia / Q000150:complications / Q000453:epidemiology*; D004522:Educational Status; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications / Q000453:epidemiology*; D008875:Middle Aged; D009483:Neuropsychological Tests; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000453:epidemiology*