Higher Education Is Associated with a Lower Risk of Dementia after a Stroke or TIA. The Rotterdam Study

Abstract

Background: Higher education is associated with a lower risk of dementia, possibly because of a higher tolerance to subclinical neurodegenerative pathology. Whether higher education also protects against dementia after clinical stroke or transient ischemic attack (TIA) remains unknown. Methods: Within the population-based Rotterdam Study, 12,561 participants free of stroke, TIA and dementia were followed for occurrence of stroke, TIA and dementia. Across the levels of education, associations of incident stroke or TIA with subsequent development of dementia and differences in cognitive decline following stroke or TIA were investigated. Results: During 124,862 person-years, 1,463 persons suffered a stroke or TIA, 1,158 persons developed dementia, of whom 186 developed dementia after stroke or TIA. Risk of dementia after a stroke or TIA, compared to no stroke or TIA, was highest in the low education category (hazards ratio [HR] 1.46, 95% CI 1.18-1.81) followed by intermediate education category (HR 1.36, 95% CI 1.03-1.81). No significant association was observed in the high education category (HR 0.62, 95% CI 0.25-1.54). In gender stratified analyses, decrease in risk of dementia with increasing education was significant only in men. Conclusion: Higher education is associated with a lower risk of dementia after stroke or TIA, particularly in men, which might be explained by a higher cognitive reserve.

Stroke and dementia risk: A systematic review and meta‐analysis

“…1). We excluded the study by Reitz and colleagues using data from the Rotterdam Study [14] due to overlap with a more recent publication from the same cohort [15] which had longer follow-up and a larger sample size.…”

“…Twelve prospective cohort studies [15,37,42,55–63] investigated the association between incident stroke and incident all-cause dementia (around 1.3 million participants and 131,217 stroke events; Appendix B, Table B2). The majority of studies included older adults and the analytic sample size ranged from 339 [62] to 799,069 [60].…”

“…When we combined adjusted results from eight studies [15,37,55,57,59,60,62,63] (849,059 participants and 125,947 stroke events), the pooled estimate indicated that incident stroke more than doubled the risk of developing all-cause dementia compared to no incident stroke (pooled RR = 2.18, 95% CI: 1.90 – 2.50, p<0.001; I 2 = 88%; 95% PI: 1.67 – 2.69, Fig. 4).…”

Risk factors associated with post-stroke dementia: a systematic review and meta-analysis

“…16,[18][19][20][21]23,25,32 Adding demographics factors showed that the risk of incident dementia elevated in relation to older age especially > 80 years (RR 4.66, 95%CI; 2.36 to 9.22) and age 70 to 79 years (RR 2.68, 95%CI; 1.52 to 4.74) versus age 60 to 69 years. 28 33 Previous mental decline was the correlation of dementia in logistic regression analysis (OR 1.20, 95%CI; 1.10 to 1.40). 31 Cognitive impairment before stroke risk of dementia after stroke showed that cognitive impairment before stroke was associated with potential covariates and diagnosis of poststroke dementia in the Helsinki Stroke Ageing Memory study cohort (OR 5.76, 95%CI; 2.84 to 11.70).…”

Determinants, Prevalence, and Trajectory of Long-Term Post-Stroke Cognitive Impairment: Results from a 4-Year Follow-Up of the ARCOS-IV Study

“…This may be attributed to a higher cognitive reserve in those stroke survivors who have higher education levels and therefore, higher tolerance to neurodegenerative pathology and cognitive decline [25]. It is also possible that those with higher education had higher socioeconomic status and more access to resources and financial support than those with lower education [26].…”