Abstract TP13: Association Between Education Level and Post-Stroke Cognitive Decline - A Pooled Cohort Analysis of Four Cohorts

Abstract

Introduction: We evaluated whether education level is associated with post-stroke cognitive decline and whether age modifies the association. Methods: We analyzed pooled data from 2,019 stroke survivors from the Atherosclerosis Risk in Communities, REasons for Geographic and Racial Differences in Stroke, Cardiovascular Health, and Framingham Offspring studies from 1971-2019. Participants ≥18 years with incident stroke and free of dementia were included (52% female and 39% Black). Repeated cognitive tests were administered in person or by telephone by trained cohort staff. Linear mixed-effects models were used to examine the association between education (less than high school, completed high school, some college, college graduate or more) and post-stroke cognitive decline for global cognition (primary outcome), executive function, and memory harmonized across cohorts and to examine effect modification by age. Median (IQR) follow-up was 4.1 (1.8, 7.2) years. Results: Compared to those with less than a high school education (n=339), stroke survivors with some college education (n=484) and stroke survivors with a college degree or more (n=583) had higher first post-stroke cognitive scores (Models M1a, M1b, and M1c, Table). Having some college education was associated with slower post-stroke decline in global cognition (Model M1a) compared to those with less than a high school education. Having some college education or a college degree was associated with faster post-stroke decline in executive function (Model M1b, Table) compared to those with less than a high school education. Significant interactions by age were lacking for all outcomes. Conclusions: Higher education level was associated with higher initial post-stroke cognitive scores, slower decline in global cognition, and faster decline in executive function, regardless of age. Stroke might narrow the gap in executive function between stroke survivors with higher and lower education.