Long education predicts recovery from stroke

Docent of Surgery and a specialist in vascular surgery, Niku Oksala, treats patients at the Stroke Unit at the Tampere University Hospital. Raimo Hyvärinen from Tampere is already recovering from cerebral infarction and cracks jokes with nurse Sanna Utriainen.

Educational attainment predicts how well people survive stroke. Better educated patients have clearly better neuropsychological abilities after the stroke, for example their memory functions and visuospatial and linguistic abilities are better.

They also live longer after the stroke.

Patients who have been educated for six years or less do the worst.

- The research gave a clear message on the importance of allocating sufficient resources to children and basic education, says Niku Oksala, Docent of Surgery and a specialist in vascular surgery at the University of Tampere and Tampere University Hospital.

His research was the first to combine the patients' educational history, wide-ranging neuropsychological assessment, the physical changes in the brain evidenced by magnetic resource imaging (MRI) analysis and long-term follow-up with Finnish patient data.

The patients, who were in their sixties and seventies, were recruited to the research in the early 1990s when they came to be treated at the Stroke Unit. They were followed up on even for as long as twelve years.

People with more education have more neural networks

Educational history reflects the so called cognitive reserve which can be assessed with neuropsychological testing.

The positive effects of education may be explained by neurons having better capacity to endure more damage when they have first been 'body-built' by education. The neurons are then also more able to mend the neural pathways that the stroke has damaged.

It can be that better educated people also get to have more neural networks. This has been shown by previous research.

- When there is bigger damage to the neural pathways, body-built brains can more easily compensate by employing alternative pathways. This can explain why better educated people are protected from the most harmful effects of a stroke, Oksala explains.

Education can also improve the patients’ responsiveness to treatment. In addition, well-educated patients are also more able to take in instructions and they are more likely to make greater changes in their life-style.

The more the better

The researched patients were divided into three groups according to their educational background: 0-6 years, 7-9 years, or over 10 years of education. The differences between these groups were big: the neuropsychological abilities improved by 40 percent and the likelihood of survival by 14 percent from the bottom group to the next.

When the category of the least educated patients is compared to the most educated group, the effect was 80 percent in terms of neuropsychological abilities. In terms of survival the effect was 28 percent.

The research did not collect data on what stage of life the patients had received their education. According to Oksala, it is likely, however, that the group of the least educated had received the minimum education available in the educational system at the time, i.e. the lower grades of primary school.

The researched patients were born in the 1920s.

It would be very interesting to Oksala to do future research on how education received at the different stages of life affects the recovery of the brain.

- Theoretically speaking children’s brains are the most malleable and dynamic. On the basis of the results it is safe to say, at the very least, that comprehensive basic education is important.

Stroke. 43(11):2931-2935, November 2012: Educational History Is an Independent Predictor of Cognitive Deficits and Long-term Survival in Postacute Patients With Mild to Moderate Ischemic Stroke

Text Tiina Lankinen
Photograph Teemu Launis
Translation Laura Tohka

This story was originally published in Finnish in Aikalainen 15/2012