![]() ![]() Cognitive reserve is a dynamic feature of brain function proposed to moderate the impact of pathology on performance 6. Cognitive reserve is defined as cognitive capacities acquired via lifetime intellectual activities, occupational-educational history, and other environmental factors, which shape the brain’s network efficiency, processing capacity, and flexibility 6. Brain reserve is originally defined by quantitative neural characteristics (e.g. In the context of neurodegenerative diseases, inter-individual variability in susceptibility to pathology is explained by concepts of brain reserve and cognitive reserve: individuals with higher reserve can tolerate more pathology and maintain function 6. Thus, comprehensively controlling for such interdependencies is mandatory for achieving unbiased insights into the factors’ genuine contribution to post-stroke cognitive outcome. At the same time, women had for a long time in general lower educational attainment than men due to the socio-demographic developments in the past. For example, women tend to be affected by stroke at an older age than men 5. However, as of yet, all these factors were mainly investigated in isolation, neither controlling for potential confoundings nor assessing mutual interactions. older age, female sex, lower educational attainment) and clinical and stroke characteristics (initial stroke severity, lesion load) constitute significant predictors for poorer post-stroke cognitive functioning 2, 3, 4. ![]() Plenty of factors have been reported to impact stroke outcome: Demographic factors (e.g. Prediction of stroke outcome remains challenging due to large inter-individual variability, which is expected to increase further as ageing of the stroke population continues and concomitant neurodegenerative changes and multi-morbidity are rising 1. ![]() This non-additive effect of cognitive reserve suggests its post-stroke protective impact on stroke outcome. In line with the hypothesis, years of education conjointly with age moderated effects of lesion on stroke outcome. We observed comparable three-way interactions for clinical scores of stroke-induced impairment and disability both in the acute and chronic stroke phase. Conversely, even small lesions led to poor cognitive outcome in older patients with lower education, but didn’t in older patients with higher education. Results revealed 46% of explained variance for cognitive outcome (p < 0.001) and yielded a significant three-way interaction: Larger lesions did not lead to cognitive impairment in younger patients with higher education, but did so in younger patients with lower education. Linear and logistic regression models were used to predict cognitive outcome (Montreal Cognitive Assessment) and stroke-induced impairment and disability (NIH Stroke Scale modified Rankin Score) in a sample of 104 chronic stroke patients carefully controlled for potential confounds. To test this hypothesis, we used age, years of education and lesion size as clinically feasible coarse proxies of brain reserve, cognitive reserve, and the extent of stroke pathology correspondingly. The concepts of brain reserve and cognitive reserve were recently suggested as valuable predictors of stroke outcome. ![]()
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