Highly Educated Folks Face Steeper Brain Decline Following Stroke

The higher you fly, the harder you fall, the old saying goes.

There might be something to that when it comes to the aftermath of a stroke, a new study suggests.

People with higher education face a steeper decline in their ability to plan, organize and problem-solve following a stroke, compared to those with less than a high school degree, researchers reported in JAMA Network Open.

The results run counter to what researchers had expected, that highly educated people would have slower brain decline following a stroke.

The study found that highly educated stroke survivors did do better than less-educated people in brain tests immediately following a stroke, but that they experienced a faster decline in their cognitive abilities during the years that followed.

“Our findings suggest that attending higher education may enable people to retain greater cognitive ability until a critical threshold of brain injury is reached after a stroke,” lead researcher Dr. Mellanie Springer, a professor of neurology at University of Michigan Medical School, said in a news release.

“At this point, compensation may fail, and rapid cognitive decline occurs,” she said.

For the study, researchers pooled data from four studies, analyzing the outcomes of more than 2,000 people without dementia who survived a stroke between 1971 and 2019.

Right after a stroke, college graduates performed better than high school dropouts across the board on tests of brain processing speed, executive function and memory, results show.

But college grads later suffered a faster decline in their executive function — skills used to manage everyday tasks, like planning and problem-solving — compared to folks who dropped out of either college or high school, researchers found.

Prior to this, experts had considered education level something that might bolster the brain against decline by boosting cognitive reserve, or the ability to preserve higher levels of functioning even in the face of a brain injury.

“Dementia is a greater threat after a first stroke than having another stroke,” senior researcher Dr. Deborah Levine, a professor of internal medicine and neurology at the University of Michigan, said in a news release.

In fact, stroke increases a person’s risk of dementia by as much as 50-fold, researchers said in background notes.

“We lack treatments that prevent or slow cognitive decline and dementia after stroke,” Levine said. “This study increases our understanding and generates potential hypotheses about the causes of post-stroke cognitive decline and which patients face higher risks of it.”

Researchers also found that genetic risk factors for Alzheimer’s did not appear to play a role in the relationship between stroke and brain decline.

That means that the critical point at which a person’s brain starts to fail does not depend on underlying genetic risk, and can be reached after just a single stroke, Springer said.

“Identifying which stroke patients are at the highest risk for cognitive decline will help target future interventions to slow cognitive decline,” Springer said.

More information

The American Stroke Association has more on the effects of stroke.

SOURCE: University of Michigan, news release, March 26, 2025

Source: HealthDay