Background and Purpose- The theory of cognitive reserve (CR) was introduced to account for individual differences in the clinical manifestation of neuropathology. This study investigated whether CR has a modulating effect on cognitive impairment and recovery after stroke. Methods- This study is an interim analysis of the Korean Stroke Cohort for Functioning and Rehabilitation. A total of 7459 patients with first-ever stroke were included for analysis. Education, occupation, and composite CR scores derived from those 2 variables were used as CR proxies. Scores from the Korean version of the Mini-Mental State Examination analyzed for 30 months after stroke onset were analyzed. Results- Lower CR increased the risk of cognitive impairment after stroke. The odds ratio was 1.89 (95% CI, 1.64-2.19) in patients with secondary education and 2.42 (95% CI, 2.03-2.90) in patients with primary education compared with patients with higher education. The odds ratio was 1.48 (95% CI, 1.23-1.98) in patients with a skilled manual occupation and 2.01 (95% CI, 1.42-2.83) in patients with a nonskilled manual occupation compared with patients with a managerial or professional occupation. In the multilevel model analysis, the Korean version of the Mini-Mental State Examination total score increased during the first 3 months (1.93 points per month) and then plateaued (0.02 point per month). The slopes were moderated by the level of education, occupation, and composite CR score: the higher the level of education, occupation, or CR score, the faster the recovery. In the older adult group, the Korean version of the Mini-Mental State Examination scores showed a long-term decline that was moderated by education level. Conclusions- Education and occupation can buffer an individual against cognitive impairment caused by stroke and promote rapid cognitive recovery early after stroke. In addition, higher education minimizes long-term cognitive decline after stroke, especially in older patients. Clinical Trial Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT03402451.

中文翻译：

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认知储备对中风后认知障碍和恢复风险的影响：KOSCO研究。

背景和目的-引入认知储备理论（CR）来解释神经病理学临床表现中的个体差异。这项研究调查了CR是否对中风后的认知障碍和恢复有调节作用。方法-本研究是对韩国卒中队列功能和康复的中期分析。总共7459例首次有中风的患者被纳入分析。从这两个变量得出的教育程度，职业和综合CR得分均用作CR代理。分析了卒中发作后30个月韩文版的迷你精神状态检查的得分。结果-较低的CR会增加中风后认知障碍的风险。接受中等教育的患者的几率是1.89（95％CI，1.64-2.19）和2.42（95％CI，2）。03-2.90）接受初等教育的患者与接受高等教育的患者相比。与具有管理性或专业性职业的患者相比，具有熟练技术性职业的患者的优势比为1.48（95％CI，1.23-1.98），而具有非技术性职业的患者的优势比为2.01（95％CI，1.42-2.83）。在多层次模型分析中，韩文的“迷你精神状态考试”总成绩在前三个月（每月1.93分）先升高，然后又稳定下来（每月0.02分）。坡度受教育程度，职业和综合CR得分的影响：教育程度，职业或CR得分越高，恢复的速度就越快。在老年人群中，韩文的“迷你精神状态考试”分数显示长期下降，受教育程度的影响有所缓和。结论：教育和职业可以减轻个体中风引起的认知障碍，并促进中风后早期的快速认知恢复。此外，高等教育可以最大程度地减少中风后的长期认知能力下降，尤其是在老年患者中。临床试验注册-URL：https：//www.clinicaltrials.gov。唯一标识符：NCT03402451。