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

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44 Scopus citations


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 languageEnglish
Pages (from-to)99-107
Number of pages9
Issue number1
StatePublished - 1 Jan 2020

Bibliographical note

Funding Information:
This study was supported by a research program funded by the Korea Centers for Disease Control and Prevention (2019E320200) and a National Research Foundation of Korea Grant funded by the Korean government (Ministry of Science, ICT and Future Planning, NRF-2017R1A2A1A05000730).

Publisher Copyright:
© 2019 The Authors.


  • cognitive dysfunction
  • cognitive reserve
  • education
  • longitudinal studies
  • occupation
  • risk factors
  • stroke


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