title: Effect of Formal Education on Vascular Cognitive Impairment after Stroke: A Meta-analysis and Study in Young-Stroke Patients.
abstract: The extent of vascular cognitive impairment (VCI) after stroke varies greatly across individuals, even when the same amount of brain damage is present. Education level is a potentially protective factor explaining these differences, but results on its effects on VCI are inconclusive.
  
  
  
  First, we performed a meta-analysis on formal education and VCI, identifying 21 studies (N=7770). Second, we examined the effect of formal education on VCI in young-stroke patients who were cognitively assessed on average 11.0 (SD=8.2) years post-stroke (the FUTURE study cohort). The total sample consisted of 277 young-stroke patients with a mean age at follow-up 50.9 (SD=10.3). Age and education-adjusted expected scores were computed using 146 matched stroke-free controls.
  
  
  
  The meta-analysis showed an overall effect size (z') of 0.25 (95% confidence interval [0.18-0.31]), indicating that formal education level had a small to medium effect on VCI. Analyses of the FUTURE data showed that the effect of education on post-stroke executive dysfunction was mediated by age (β age -0.015; p<.05). Below-average performance in the attention domain was more frequent for low-education patients (χ2(2)=9.8; p<.05).
  
  
  
  While education level was found to be related to post-stroke VCI in previous research, the effects were small. Further analysis in a large stroke cohort showed that these education effects were fully mediated by age, even in relatively young stroke patients. Education level in and of itself does not appear to be a valid indicator of cognitive reserve. Multi-indicator methods may be more valid, but have not been studied in relation to VCI. (JINS, 2017, 23, 223-238).
authors.affiliation: 1Donders Institute for Brain,Cognition and Behaviour,Radboud University,Nijmegen,the Netherlands.
authors.forename: Roy P C
authors.initials: RP
authors.lastname: Kessels
authors.affiliation: 1Donders Institute for Brain,Cognition and Behaviour,Radboud University,Nijmegen,the Netherlands.
authors.forename: Willem Sake
authors.initials: WS
authors.lastname: Eikelboom
authors.affiliation: 4Department of Neurology,Radboud University Medical Center,Nijmegen,the Netherlands.
authors.forename: Pauline
authors.initials: P
authors.lastname: Schaapsmeerders
authors.affiliation: 4Department of Neurology,Radboud University Medical Center,Nijmegen,the Netherlands.
authors.forename: Noortje A M
authors.initials: NA
authors.lastname: Maaijwee
authors.affiliation: 4Department of Neurology,Radboud University Medical Center,Nijmegen,the Netherlands.
authors.forename: Renate M
authors.initials: RM
authors.lastname: Arntz
authors.affiliation: 1Donders Institute for Brain,Cognition and Behaviour,Radboud University,Nijmegen,the Netherlands.
authors.forename: Ewoud J
authors.initials: EJ
authors.lastname: van Dijk
authors.affiliation: 1Donders Institute for Brain,Cognition and Behaviour,Radboud University,Nijmegen,the Netherlands.
authors.forename: Frank-Erik
authors.initials: FE
authors.lastname: de Leeuw
mesh_terms: D060825:Cognitive Dysfunction / Q000150:complications / Q000209:etiology*; D015140:Dementia, Vascular / Q000150:complications / Q000209:etiology*; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D039781:PubMed / Q000706:statistics & numerical data; D020521:Stroke / Q000150:complications*
keywords: Aging; Cerebrovascular disease; Cognitive reserve; Education; Ischemic stroke; Quantitative meta-analysis; Review; Young stroke