Working is Protective for Post-stroke Cognitive Decline

Keeping busy is widely regarded as important for maintaining cognitive fidelity and overall brain health. However, stay-at-home orders and rising unemployment during the current pandemic have made this particularly challenging. 

Underscoring the importance of mental activity to brain health, researchers at Tel Aviv Medical Center led by Prof. Einor Ben Assayag recently found a link between occupational status and cognitive function after a stroke. Specifically, patients who were employed prior to the stroke had better cognitive performance compared to those who were unemployed. Further, employed patients who resumed working had better cognitive function than those who never returned to work.

The findings are based on a large clinical cohort of stroke patients (Tel Aviv Brain Acute Stroke Cohort; TABASCO) tested with NeuroTrax computerized cognitive assessment at admission, as well as 6, 12, and 24 months later. Data were analyzed from 273 first-ever stroke survivors of working age, of which 174 were employed prior to the stroke. Pre-stroke unemployment was associated with diabetes, hypertension, dyslipidemia, depression, poorer cognitive scores and brain atrophy. Further, post-stroke cognitive decline was more prevalent among previously unemployed patients. Of patients who had been employed, those who returned to work had higher cognitive scores and fewer depressive symptoms.  Engaging in mentally stimulating jobs reduced risk of cognitive decline, and participation in social activities conferred partial protection against cognitive decline even in unemployed patients.

These results confirm that keeping busy is indeed protective against cognitive decline. Specifically, people who are employed experience less cognitive decline associated with a stroke, and those who return to work after a stroke have less chance of cognitive decline. Notably, the study design highlights the value of longitudinal follow-up with validated tools to track changes in cognitive performance. Based on their results, the authors advise clinicians to emphasize the importance of work resumption and social engagement after a stroke. More generally, brain health should be safeguarded amid the current pandemic by exploiting remote employment and social networking opportunities.

Hallevi, H., Molad, J., Kliper, E., Seyman, E., Niry, D., Bornstein, N.M., and Ben Assayag, E. (2020). Working status is related to post stroke/TIA cognitive decline: Data from the TABASCO study. Journal of Stroke and Cerebrovascular Diseases, 29:105019. PMID: 32807434