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A Swedish observational study of 4,912 adults found that, among participants ages 60 to 69, lower scores in overall thinking ability, memory and processing speed were associated with higher risk of a first stroke. The pattern was not seen in participants ages 70 and older after researchers adjusted for other factors; the study cannot show that lower cognitive scores cause strokes.
A Swedish study found that adults ages 60 to 69 with lower scores on tests of thinking ability, memory and processing speed had a higher likelihood of a first stroke during follow-up. The research, published September 30 in the Journal of the American Heart Association, tracked 4,912 adults; its observational design means it identifies an association, not proof that cognitive performance causes stroke.
Researchers compared participants with the lowest cognitive scores with those who had the highest scores. Among people ages 60 to 69, lower overall thinking ability was associated with an 86% higher stroke risk. Lower memory scores were associated with a 68% higher risk, while lower information-processing speed scores were associated with a 66% higher risk. These percentages describe the study’s comparisons between score groups; they do not establish an individual’s likelihood of having a stroke.
During an average 12.3 years of follow-up, 572 participants experienced a first stroke, representing more than 10% of the study group. Researchers used records from Sweden’s National Patient Register to identify stroke events. At enrollment, participants were at least 60 years old, 46% were men, and none had a known history of dementia, stroke or transient ischemic attack, often called a mini-stroke.
Participants completed standardized tests covering memory, processing speed, verbal fluency and executive function, among other skills. Researchers grouped scores into low, middle and high levels within age groups, and calculated overall thinking ability from available test results. After accounting for health and lifestyle factors, the same pattern of higher stroke risk at lower cognitive scores was not found among those ages 70 to 79 or 80 and older.
Why Midlife Scores May Matter
The results suggest that cognitive test performance in a person’s 60s may be associated with later stroke risk, giving researchers a possible factor to examine alongside established health and lifestyle measures. The study does not show that cognitive tests can predict which person will have a stroke, or that raising a test score would prevent one. Its findings may help guide further research into how brain health and vascular health relate during midlife.
Elisabeth Breese Marsh, a neurologist at Johns Hopkins University who was not involved in the study, said the findings support attention to vascular risk factors and brain health before older age. She also described cognitive performance as a potential screening factor for identifying people at elevated risk, while noting that researchers do not know whether cognitive impairment itself contributes to stroke risk. Any use of cognitive scores in screening would require further study.
How Researchers Tracked Stroke Risk
The study drew on the Good Aging in Skåne project and Swedish health data. Participants enrolled between 2001 and 2023. Researchers assessed cognitive function at study visits and linked participants to specialized inpatient and outpatient records to identify first-time strokes during follow-up.
Lead author Alice Askemyr, a geriatrics researcher at Lund University and Skåne University Hospital in Malmö, said the team analyzed separate age spans because health and medication patterns vary among older adults. People in their 60s may have fewer medical conditions than people in their 80s, she said, and a factor linked to risk earlier in life may not have the same relationship when it appears later.
Askemyr also raised the possibility that lower cognitive scores among some participants in their 60s could reflect an undetected prior brain injury, which might also relate to future stroke risk. She said silent brain injuries can affect cognition and cited their prevalence among adults over 70. That explanation is a hypothesis offered by the study’s lead author; this analysis did not establish that such injuries accounted for the association.
““We chose to investigate different age spans because the older population is very diverse.””
— Alice Askemyr, M.D., lead study author
What the Study Cannot Establish
Because this was an observational study, it cannot determine whether lower cognitive scores contribute to stroke risk, whether an underlying condition affects both, or whether another factor explains some of the association. The researchers adjusted for health and lifestyle factors, but adjustment cannot rule out every possible source of bias or confounding.
The age pattern also needs further examination: the associations reported for people ages 60 to 69 were not seen in the older groups after adjustment. The study does not establish why the relationship differed by age, whether the findings apply to other populations, or whether cognitive testing would improve existing stroke-risk assessments. Askemyr noted that differences in healthcare, socioeconomic conditions and lifestyle could limit how well the results generalize beyond Sweden.
Further Research Across Age Groups
The study reports results from a long-running Swedish cohort, but it does not specify a next study or a planned change to clinical screening. Further research would need to test whether the age-specific association appears in other populations and clarify what factors may explain it. Researchers would also need to determine whether cognitive scores add useful information to established assessments of stroke risk.
For now, the findings are evidence of a link in one Swedish study group, not a clinical prediction rule. Marsh’s comments on risk-factor management reflect her advice as an outside expert, not a conclusion that this study tested a prevention strategy. The reported analysis offers no evidence that treatment based on cognitive scores prevents strokes.
Key Questions
What did the Swedish study find?
Among participants ages 60 to 69, lower scores in overall thinking ability, memory and processing speed were associated with higher risk of a first stroke during follow-up. The study did not find the same adjusted pattern among participants ages 70 and older.
How many people had a stroke during the study?
Of the 4,912 participants, 572 had a first stroke during an average 12.3 years of follow-up. Researchers identified events through Sweden’s National Patient Register.
Does the study show that lower cognitive scores cause strokes?
No. The research was observational, so it found an association but cannot establish cause and effect. It also cannot show that changing cognitive scores would prevent a stroke.
Could these findings apply outside Sweden?
That is uncertain. The lead author said differences in healthcare, socioeconomic conditions and lifestyle between countries may limit how well the results apply elsewhere. The association needs study in other populations.
Source: rss
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