Kessels Roy P C, Eikelboom Willem Sake, Schaapsmeerders Pauline, Maaijwee Noortje A M, Arntz Renate M, van Dijk Ewoud J, de Leeuw Frank-Erik
1Donders Institute for Brain,Cognition and Behaviour,Radboud University,Nijmegen,the Netherlands.
4Department of Neurology,Radboud University Medical Center,Nijmegen,the Netherlands.
J Int Neuropsychol Soc. 2017 Mar;23(3):223-238. doi: 10.1017/S1355617716001016. Epub 2017 Jan 9.
The extent of vascular cognitive impairment (VCI) after stroke varies greatly across individuals, even when the same amount of brain damage is present. Education level is a potentially protective factor explaining these differences, but results on its effects on VCI are inconclusive.
First, we performed a meta-analysis on formal education and VCI, identifying 21 studies (N=7770). Second, we examined the effect of formal education on VCI in young-stroke patients who were cognitively assessed on average 11.0 (SD=8.2) years post-stroke (the FUTURE study cohort). The total sample consisted of 277 young-stroke patients with a mean age at follow-up 50.9 (SD=10.3). Age and education-adjusted expected scores were computed using 146 matched stroke-free controls.
The meta-analysis showed an overall effect size (z') of 0.25 (95% confidence interval [0.18-0.31]), indicating that formal education level had a small to medium effect on VCI. Analyses of the FUTURE data showed that the effect of education on post-stroke executive dysfunction was mediated by age (β age -0.015; p<.05). Below-average performance in the attention domain was more frequent for low-education patients (χ2(2)=9.8; p<.05).
While education level was found to be related to post-stroke VCI in previous research, the effects were small. Further analysis in a large stroke cohort showed that these education effects were fully mediated by age, even in relatively young stroke patients. Education level in and of itself does not appear to be a valid indicator of cognitive reserve. Multi-indicator methods may be more valid, but have not been studied in relation to VCI. (JINS, 2017, 23, 223-238).
即使存在相同程度的脑损伤，中风后血管性认知障碍（VCI）的程度在个体间仍存在很大差异。教育水平是解释这些差异的一个潜在保护因素，但其对VCI影响的研究结果尚无定论。
首先，我们对正规教育与VCI进行了一项荟萃分析，共纳入21项研究（N = 7770）。其次，我们研究了正规教育对年轻中风患者VCI的影响，这些患者在中风后平均11.0（标准差 = 8.2）年接受了认知评估（FUTURE研究队列）。总样本包括277名年轻中风患者，随访时的平均年龄为50.9（标准差 = 10.3）。使用146名匹配的无中风对照计算年龄和教育调整后的预期分数。
荟萃分析显示总体效应量（z'）为0.25（95%置信区间[0.18 - 0.31]），表明正规教育水平对VCI有小到中等程度的影响。对FUTURE数据的分析表明，教育对中风后执行功能障碍的影响由年龄介导（β年龄 -0.015；p <.05）。低教育水平患者在注意力领域表现低于平均水平的情况更为常见（χ2(2)=9.8；p <.05）。
虽然先前的研究发现教育水平与中风后VCI有关，但其影响较小。在一个大型中风队列中的进一步分析表明，即使在相对年轻的中风患者中，这些教育影响也完全由年龄介导。教育水平本身似乎并不是认知储备的有效指标。多指标方法可能更有效，但尚未针对VCI进行研究。（《日本神经精神疾病杂志》，2017年，第23卷，第223 - 238页）
