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

69 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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title = "Effect of Cognitive Reserve on Risk of Cognitive Impairment and Recovery After Stroke: The KOSCO Study",

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.",

year = "2020",

month = jan,

day = "1",

doi = "10.1161/STROKEAHA.119.026829",

language = "English",

volume = "51",

pages = "99--107",

journal = "Stroke",

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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

PY - 2020/1/1

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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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KW - occupation

KW - risk factors

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ER -

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

Abstract

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Keywords

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