A recent analysis of over 2,000 stroke survivors led by CAPRA’s Dr. Mellanie Springer (1971–2019) found that individuals with higher education levels performed better on initial assessments of global cognition—including memory, attention, and processing speed—immediately following a stroke. College graduates scored nearly two points higher in executive function at baseline compared to those with less than a high school education.
However, the study published in JAMA Network Open observed that higher education was linked to a more rapid decline in executive function over time. College-educated survivors experienced declines at a rate approximately 0.44 points per year faster than their less-educated counterparts, with those having some college education also showing accelerated decline (−0.30 points/year).
Researchers attribute this to the concept of “cognitive reserve”: education delays the visible effects of brain injury until a critical threshold is reached, after which compensatory mechanisms collapse and decline accelerates.
Notably, the trend was not influenced by the presence of the ApoE4 Alzheimer’s gene or by having multiple strokes.
These findings emphasize that while education may mask early deficits, it does not prevent eventual decline—highlighting the need for proactive cognitive monitoring and intervention, regardless of a patient’s intellectual background.