The impact of pre-stroke formal education on language test performance in aphasic and non-aphasic stroke survivors.

The study was observational and used existing database records, so it cannot show that education caused higher language scores. Language testing happened at very different times after stroke, from 17 days to 42 years, and most tests were in the chronic stage, so early recovery was not well captured. Different analyses used different participant numbers because some data were missing; 182 participants were excluded from relevant analyses for several variables. Education was defined only as formal school or university education since age 14, excluding apprenticeships and work-related qualifications, and socioeconomic status was not measured, so the education effect may reflect other background differences. Recovery was based on retrospective self- or carer-reported ability at one week and one year, which relies on memory and insight and can contain measurement error. The sample was mainly native English speakers and included more participants from London and the South East of England than from the North East, so it may not represent all stroke populations. Participants with large left-hemisphere lesions and severe initial aphasia had low scores regardless of education, so the study says little about how education affects the most impaired group. The non-aphasic comparison group consisted of stroke survivors who reported normal language, not people without stroke, so generic education effects could still influence the results.

The work was funded by Wellcome, the Medical Research Council and the Stroke Association grants to named authors. The supplied text does not report additional conflict-of-interest declarations.

Do not read this as evidence that more education improves aphasia recovery or protects against aphasia. The positive finding was a small association with test scores, and the recovery analyses were null.