{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T01:09:28Z","timestamp":1791335368045,"version":"4.3.1"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:sec>\n            <jats:title>Background and Purpose\u2014<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods\u2014<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results\u2014<\/jats:title>\n            <jats:p>Lower CR increased the risk of cognitive impairment after stroke. The odds ratio was 1.89 (95% CI, 1.64\u20132.19) in patients with secondary education and 2.42 (95% CI, 2.03\u20132.90) in patients with primary education compared with patients with higher education. The odds ratio was 1.48 (95% CI, 1.23\u20131.98) in patients with a skilled manual occupation and 2.01 (95% CI, 1.42\u20132.83) 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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical Trial Registration\u2014<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              . Unique identifier: NCT03402451.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.119.026829","type":"journal-article","created":{"date-parts":[[2019,12,11]],"date-time":"2019-12-11T10:00:25Z","timestamp":1576058425000},"page":"99-107","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":91,"title":["Effect of Cognitive Reserve on Risk of Cognitive Impairment and Recovery After Stroke"],"prefix":"10.1161","volume":"51","author":[{"given":"Minyoung","family":"Shin","sequence":"first","affiliation":[{"name":"From the Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (M.S., W.H.C., M.A.S., Y.-H.K.)"},{"name":"Department of Counseling Psychology, Yongmoon Graduate School of Counseling Psychology, Seoul, Republic of Korea (M.S.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min Kyun","family":"Sohn","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, School of Medicine, Chungnam National University, Daejeon, Republic of Korea (M.K.S.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jongmin","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea (J.L.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deog Young","family":"Kim","sequence":"additional","affiliation":[{"name":"Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (D.Y.K.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam-Gyu","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Kwangju, Republic of Korea (S.-G.L.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong-Il","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Republic of Korea (Y.-I.S.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gyung-Jae","family":"Oh","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, Wonkwang University, School of Medicine, Iksan, Republic of Korea (G.-J.O.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang-Soo","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Kyungpook National University, School of Medicine, Daegu, Republic of Korea (Y.-S.L.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min Cheol","family":"Joo","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea (M.C.J.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun Young","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Jeju National University School of Medicine, Republic of Korea (E.Y.H.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junhee","family":"Han","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeonghoon","family":"Ahn","sequence":"additional","affiliation":[{"name":"Department of Statistics, Hallym University, Chuncheon, Republic of Korea (J.A.)"},{"name":"Department of Health Convergence, Ewha Womans University, Seoul, Republic of Korea (J.A,)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Won 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