Working before and after stroke associated with better brain health

People who are employed before and after suffering stroke are more likely than unemployed individuals to maintain cognitive function and avoid depression two years post-stroke, according to research presented Jan. 25 at the International Stroke Conference in Los Angeles.

Senior study author Einor Ben Assayag, PhD, and colleagues studied 252 working-age adults who experienced their first mild stroke or transient ischemic attack (TIA). Patients suffering more severe strokes weren’t included.

Brain health was assessed in the early stages after stroke, and then again one and two years later.

Assayag et al. found:

• People who were unemployed before stroke were 320 percent more likely to develop cognitive decline with two years of the stroke.
• They were also more likely to have worse neurological deficit, higher depression scores and more elevated inflammation. In addition, they showed reduced cortical thickness and white matter volume on imaging studies, and were more likely to have type 2 diabetes and high blood pressure.
• Returning to work after stroke was associated with a lower risk of cognitive decline.

“The message here is ‘keep on working,’” Ben Assayag, senior researcher in the neurology department at Tel-Aviv Sorasky Medical Center in Israel, said in a press release. “Rates of death and cognitive decline were higher among the unemployed people we studied. In fact, being unemployed was by itself a risk factor for cognitive decline and death.”

American Stroke Association spokesperson Brian Silver, MD, pointed out two key limitations to the study—it had a relatively small sample size and it was impossible to infer employment directly caused cognitive changes.

“We don't know the reasons that people stopped working before the stroke,” said Silver, a professor of neurology at University of Massachusetts Medical School. “It could be for a variety of reasons, including the fact that they were already having cognitive problems, and that's what led them to stop working, or as another example, they may have had depression, which also led them to stop working. So, we don't know, really, whether or not stopping working for sure leads to the cognitive decline.”

However, Silver said the study indicates there is “some benefit” to remaining employed after a stroke and warrants a discussion about whether post-stroke counseling should focus on getting patients back to work. But people may find other ways to keep their minds sharp, he said.

“Let's say you stop working, but you start taking up avid travel, do a lot of walking, reading about the areas that you're visiting,” Silver said. “Might that be a reasonable surrogate for working? So ... I'm not sure we can say that you should just keep working to try to maintain your brain health. Maybe working itself is a surrogate for keeping physically active and keeping your mind active."