Swedish Study Links Lower Midlife Cognitive Scores To Future Strokes

TL;DR

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A Swedish observational study found that adults aged 60 to 69 with lower scores in overall thinking, memory and information-processing speed had higher rates of first-time stroke over follow-up. The association was not seen in participants aged 70 and older after adjustments, and the study cannot show that lower cognitive performance causes stroke.

A Swedish study found that adults aged 60 to 69 who scored lower on tests of thinking ability, memory and information-processing speed were more likely to have a first-time stroke during later follow-up. The research, published in the Journal of the American Heart Association, included nearly 5,000 people but found no corresponding pattern among participants aged 70 and older after accounting for health and lifestyle factors.

The study followed 4,912 adults aged 60 and older enrolled in the Good Aging in Skåne project. Participants had no history of dementia, stroke or transient ischemic attack when enrolled. Researchers assessed cognition using standardized tests that covered memory, processing speed, verbal fluency and executive function, then grouped performance by age into low, middle and high scores.

Over an average of 12.3 years, 572 participants experienced a first-time stroke, according to data drawn from Sweden’s National Patient Register. Among people aged 60 to 69, those in the lowest score group for overall thinking ability had an estimated 86% higher stroke risk than those in the highest group. Lower memory scores were associated with a 68% higher risk, and lower processing-speed scores with a 66% higher risk.

Those percentages describe comparisons between the lowest- and highest-performing groups in the 60-to-69 age range; they do not establish how likely any individual is to have a stroke. The researchers said the same cognitive-score pattern was not found among participants aged 70 to 79 or 80 and older after adjustment for other health and lifestyle factors. The study was observational, so it identifies an association rather than proving that cognitive changes cause strokes.

Cognitive Scores May Flag Midlife Risk

The findings raise the possibility that cognitive test performance could help identify a group of adults in their 60s who may warrant closer attention to vascular and brain health. That possibility matters because many established stroke risks, including some related to health and lifestyle, can be discussed with clinicians before a stroke occurs. The study does not show that testing cognition prevents strokes, or that a low score should be treated as a diagnosis.

Lead author Alice Askemyr, a geriatrics researcher at Lund University and Skåne University Hospital, said lower performance in the younger age group might sometimes reflect an earlier, unrecognized brain injury. She described so-called silent injuries as a possible explanation, not a demonstrated cause in this study. The research did not establish whether cognitive impairment itself adds to stroke risk or instead signals underlying processes that also affect stroke risk.

Elisabeth Breese Marsh, a neurologist at Johns Hopkins who was not involved in the research, said the study supports attention to vascular risk factors and brain-health habits in midlife. Her comments reflect an expert interpretation of the results; the study itself did not test a prevention program or measure the effects of changing risk factors.

How Researchers Tracked Stroke Risk

The analysis used health data collected in Sweden between 2001 and 2023, combining cognitive assessments from the Good Aging in Skåne project with records of first-time stroke events. Participants were 46% men and were at least 60 years old at enrollment. Researchers compared later stroke incidence across age-specific cognitive performance groups.

Askemyr said the team examined separate age spans because older adults are not a uniform group: people in their 60s may differ from people in their 80s in medical conditions and medication use. The paper’s age-specific result is therefore important to interpret narrowly. The reported association applied to adults aged 60 to 69, while the adjusted analysis did not show the same relationship in the older groups.

The report appeared in the American Heart Association’s open-access, peer-reviewed journal. The study’s authors also cautioned that findings from a Swedish population may not apply in the same way elsewhere, given possible differences in health care, socioeconomic conditions and lifestyle.

“We chose to investigate different age spans because the older population is very diverse.”

— Alice Askemyr, lead author and geriatrics researcher at Lund University and Skåne University Hospital

What the Study Cannot Establish

The research cannot determine whether lower cognitive performance causes stroke, results from an earlier brain change, or is associated with other factors that influence stroke risk. The authors also did not establish that cognitive testing can predict an individual’s outcome or that adding such tests to routine screening would reduce stroke incidence.

The absence of a similar adjusted association in participants aged 70 and older does not show that cognition is irrelevant to stroke risk in those ages. The analysis may reflect differences among age groups, other health conditions or factors not captured by the study. The findings may also have limited generalizability beyond Sweden, as the authors noted.

The reported risk comparisons concern groups with the lowest and highest cognitive scores, not a personal forecast. The available report does not provide enough information to translate those relative differences into an individual’s absolute probability of stroke.

Further Studies and Clinical Questions

Further research would be needed to test whether cognitive scores add useful information to existing stroke-risk assessments, whether the association appears in populations outside Sweden and what may explain the age-specific pattern. Studies designed to examine mechanisms could help distinguish whether cognitive changes are an early sign of underlying brain or vascular problems or contribute independently to later risk.

For now, the study adds an observational finding rather than a new clinical recommendation. People concerned about cognition or stroke risk can discuss their circumstances with a qualified health professional, who can assess established risk factors and decide whether further evaluation is appropriate. No prevention intervention was tested in this research.

Key Questions

What did the Swedish study find?

Among adults aged 60 to 69, lower scores in overall thinking, memory and processing speed were associated with higher risk of first-time stroke during follow-up. The adjusted pattern was not found in participants aged 70 and older.

How many people took part, and how long were they followed?

The study included 4,912 adults. Participants were followed for an average of 12.3 years, during which 572 had a first-time stroke.

Does the study prove that low cognitive scores cause strokes?

No. It was an observational study, which can identify an association but cannot establish cause and effect. The researchers said earlier, undetected brain injury might be one possible explanation.

Do the results apply to people over 70?

The study did not find the same association in its 70-to-79 and 80-and-older groups after adjustment for other factors. That result does not prove there is no relationship in older adults; it means this analysis did not detect the same pattern.

Can a cognitive test predict an individual’s stroke risk?

The study does not establish that a cognitive score can forecast an individual’s stroke or replace existing clinical assessments. Its results compare groups and require further research before their use as a screening tool can be determined.

Source: rss