Effect of Cognitive Reserve on Risk of Cognitive Impairment and Recovery After Stroke: The KOSCO Study

Minyoung Shin; Min Kyun Sohn; Jongmin Lee; Deog Young Kim; Sam Gyu Lee; Yong Il Shin; Gyung Jae Oh; Yang Soo Lee; Min Cheol Joo; Eun Young Han; Junhee Han; Jeonghoon Ahn; Won Hyuk Chang; Min A. Shin; Ji Yoo Choi; Sung Hyun Kang; Youngtaek Kim; Yun Hee Kim

doi:10.1161/STROKEAHA.119.026829

Effect of Cognitive Reserve on Risk of Cognitive Impairment and Recovery After Stroke: The KOSCO Study

Minyoung Shin, Min Kyun Sohn, Jongmin Lee, Deog Young Kim, Sam Gyu Lee, Yong Il Shin, Gyung Jae Oh, Yang Soo Lee, Min Cheol Joo, Eun Young Han, Junhee Han, Jeonghoon Ahn, Won Hyuk Chang, Min A. Shin, Ji Yoo Choi, Sung Hyun Kang, Youngtaek Kim, Yun Hee Kim

Department of Health Convergence

Research output: Contribution to journal › Article › peer-review

57 Scopus citations

Abstract

Background and Purpose - The theory of cognitive reserve (CR) was introduced to account for individual differences in the clinical manifestation of neuropathology. This study investigated whether CR has a modulating effect on cognitive impairment and recovery after stroke. Methods - This study is an interim analysis of the Korean Stroke Cohort for Functioning and Rehabilitation. A total of 7459 patients with first-ever stroke were included for analysis. Education, occupation, and composite CR scores derived from those 2 variables were used as CR proxies. Scores from the Korean version of the Mini-Mental State Examination analyzed for 30 months after stroke onset were analyzed. Results - Lower CR increased the risk of cognitive impairment after stroke. The odds ratio was 1.89 (95% CI, 1.64-2.19) in patients with secondary education and 2.42 (95% CI, 2.03-2.90) in patients with primary education compared with patients with higher education. The odds ratio was 1.48 (95% CI, 1.23-1.98) in patients with a skilled manual occupation and 2.01 (95% CI, 1.42-2.83) in patients with a nonskilled manual occupation compared with patients with a managerial or professional occupation. In the multilevel model analysis, the Korean version of the Mini-Mental State Examination total score increased during the first 3 months (1.93 points per month) and then plateaued (0.02 point per month). The slopes were moderated by the level of education, occupation, and composite CR score: the higher the level of education, occupation, or CR score, the faster the recovery. In the older adult group, the Korean version of the Mini-Mental State Examination scores showed a long-term decline that was moderated by education level. Conclusions - Education and occupation can buffer an individual against cognitive impairment caused by stroke and promote rapid cognitive recovery early after stroke. In addition, higher education minimizes long-term cognitive decline after stroke, especially in older patients.

Original language	English
Pages (from-to)	99-107
Number of pages	9
Journal	Stroke
Volume	51
Issue number	1
DOIs	https://doi.org/10.1161/STROKEAHA.119.026829
State	Published - 1 Jan 2020

Bibliographical note

Publisher Copyright:
© 2019 The Authors.

Keywords

cognitive dysfunction
cognitive reserve
education
longitudinal studies
occupation
risk factors
stroke

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10.1161/STROKEAHA.119.026829

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Shin, M., Sohn, M. K., Lee, J., Kim, D. Y., Lee, S. G., Shin, Y. I., Oh, G. J., Lee, Y. S., Joo, M. C., Han, E. Y., Han, J., Ahn, J., Chang, W. H., Shin, M. A., Choi, J. Y., Kang, S. H., Kim, Y., & Kim, Y. H. (2020). Effect of Cognitive Reserve on Risk of Cognitive Impairment and Recovery After Stroke: The KOSCO Study. Stroke, 51(1), 99-107. https://doi.org/10.1161/STROKEAHA.119.026829

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abstract = "Background and Purpose - The theory of cognitive reserve (CR) was introduced to account for individual differences in the clinical manifestation of neuropathology. This study investigated whether CR has a modulating effect on cognitive impairment and recovery after stroke. Methods - This study is an interim analysis of the Korean Stroke Cohort for Functioning and Rehabilitation. A total of 7459 patients with first-ever stroke were included for analysis. Education, occupation, and composite CR scores derived from those 2 variables were used as CR proxies. Scores from the Korean version of the Mini-Mental State Examination analyzed for 30 months after stroke onset were analyzed. Results - Lower CR increased the risk of cognitive impairment after stroke. The odds ratio was 1.89 (95% CI, 1.64-2.19) in patients with secondary education and 2.42 (95% CI, 2.03-2.90) in patients with primary education compared with patients with higher education. The odds ratio was 1.48 (95% CI, 1.23-1.98) in patients with a skilled manual occupation and 2.01 (95% CI, 1.42-2.83) in patients with a nonskilled manual occupation compared with patients with a managerial or professional occupation. In the multilevel model analysis, the Korean version of the Mini-Mental State Examination total score increased during the first 3 months (1.93 points per month) and then plateaued (0.02 point per month). The slopes were moderated by the level of education, occupation, and composite CR score: the higher the level of education, occupation, or CR score, the faster the recovery. In the older adult group, the Korean version of the Mini-Mental State Examination scores showed a long-term decline that was moderated by education level. Conclusions - Education and occupation can buffer an individual against cognitive impairment caused by stroke and promote rapid cognitive recovery early after stroke. In addition, higher education minimizes long-term cognitive decline after stroke, especially in older patients.",

keywords = "cognitive dysfunction, cognitive reserve, education, longitudinal studies, occupation, risk factors, stroke",

author = "Minyoung Shin and Sohn, {Min Kyun} and Jongmin Lee and Kim, {Deog Young} and Lee, {Sam Gyu} and Shin, {Yong Il} and Oh, {Gyung Jae} and Lee, {Yang Soo} and Joo, {Min Cheol} and Han, {Eun Young} and Junhee Han and Jeonghoon Ahn and Chang, {Won Hyuk} and Shin, {Min A.} and Choi, {Ji Yoo} and Kang, {Sung Hyun} and Youngtaek Kim and Kim, {Yun Hee}",

note = "Publisher Copyright: {\textcopyright} 2019 The Authors.",

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doi = "10.1161/STROKEAHA.119.026829",

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T1 - Effect of Cognitive Reserve on Risk of Cognitive Impairment and Recovery After Stroke

T2 - The KOSCO Study

AU - Shin, Minyoung

AU - Sohn, Min Kyun

AU - Lee, Jongmin

AU - Kim, Deog Young

AU - Lee, Sam Gyu

AU - Shin, Yong Il

AU - Oh, Gyung Jae

AU - Lee, Yang Soo

AU - Joo, Min Cheol

AU - Han, Eun Young

AU - Han, Junhee

AU - Ahn, Jeonghoon

AU - Chang, Won Hyuk

AU - Shin, Min A.

AU - Choi, Ji Yoo

AU - Kang, Sung Hyun

AU - Kim, Youngtaek

AU - Kim, Yun Hee

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N2 - Background and Purpose - The theory of cognitive reserve (CR) was introduced to account for individual differences in the clinical manifestation of neuropathology. This study investigated whether CR has a modulating effect on cognitive impairment and recovery after stroke. Methods - This study is an interim analysis of the Korean Stroke Cohort for Functioning and Rehabilitation. A total of 7459 patients with first-ever stroke were included for analysis. Education, occupation, and composite CR scores derived from those 2 variables were used as CR proxies. Scores from the Korean version of the Mini-Mental State Examination analyzed for 30 months after stroke onset were analyzed. Results - Lower CR increased the risk of cognitive impairment after stroke. The odds ratio was 1.89 (95% CI, 1.64-2.19) in patients with secondary education and 2.42 (95% CI, 2.03-2.90) in patients with primary education compared with patients with higher education. The odds ratio was 1.48 (95% CI, 1.23-1.98) in patients with a skilled manual occupation and 2.01 (95% CI, 1.42-2.83) in patients with a nonskilled manual occupation compared with patients with a managerial or professional occupation. In the multilevel model analysis, the Korean version of the Mini-Mental State Examination total score increased during the first 3 months (1.93 points per month) and then plateaued (0.02 point per month). The slopes were moderated by the level of education, occupation, and composite CR score: the higher the level of education, occupation, or CR score, the faster the recovery. In the older adult group, the Korean version of the Mini-Mental State Examination scores showed a long-term decline that was moderated by education level. Conclusions - Education and occupation can buffer an individual against cognitive impairment caused by stroke and promote rapid cognitive recovery early after stroke. In addition, higher education minimizes long-term cognitive decline after stroke, especially in older patients.

AB - Background and Purpose - The theory of cognitive reserve (CR) was introduced to account for individual differences in the clinical manifestation of neuropathology. This study investigated whether CR has a modulating effect on cognitive impairment and recovery after stroke. Methods - This study is an interim analysis of the Korean Stroke Cohort for Functioning and Rehabilitation. A total of 7459 patients with first-ever stroke were included for analysis. Education, occupation, and composite CR scores derived from those 2 variables were used as CR proxies. Scores from the Korean version of the Mini-Mental State Examination analyzed for 30 months after stroke onset were analyzed. Results - Lower CR increased the risk of cognitive impairment after stroke. The odds ratio was 1.89 (95% CI, 1.64-2.19) in patients with secondary education and 2.42 (95% CI, 2.03-2.90) in patients with primary education compared with patients with higher education. The odds ratio was 1.48 (95% CI, 1.23-1.98) in patients with a skilled manual occupation and 2.01 (95% CI, 1.42-2.83) in patients with a nonskilled manual occupation compared with patients with a managerial or professional occupation. In the multilevel model analysis, the Korean version of the Mini-Mental State Examination total score increased during the first 3 months (1.93 points per month) and then plateaued (0.02 point per month). The slopes were moderated by the level of education, occupation, and composite CR score: the higher the level of education, occupation, or CR score, the faster the recovery. In the older adult group, the Korean version of the Mini-Mental State Examination scores showed a long-term decline that was moderated by education level. Conclusions - Education and occupation can buffer an individual against cognitive impairment caused by stroke and promote rapid cognitive recovery early after stroke. In addition, higher education minimizes long-term cognitive decline after stroke, especially in older patients.

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Effect of Cognitive Reserve on Risk of Cognitive Impairment and Recovery After Stroke: The KOSCO Study

Abstract

Bibliographical note

Keywords

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