Swedish Study Links Lower Midlife Cognitive Scores To Future Strokes

TL;DR

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A Swedish observational study of 4,912 adults found that, among those aged 60 to 69, lower scores in overall thinking, memory and processing speed were associated with greater risk of a first stroke during follow-up. The association was not observed among participants aged 70 to 79 or 80 and older after adjustment for other factors; the study cannot show that lower cognition causes stroke.

A Swedish study of 4,912 adults aged 60 and older found that lower scores on tests of thinking, memory and information-processing speed were associated with a greater risk of a first stroke among participants aged 60 to 69. The age-specific association was not seen among adults aged 70 to 79 or 80 and older after researchers accounted for other health and lifestyle factors, and the observational findings do not establish that cognitive performance causes stroke.

The study, published September 30 in the Journal of the American Heart Association, examined participants in Sweden’s Good Aging in Skåne project. They had no history of dementia, stroke or transient ischemic attack when included. Researchers assessed cognition using standardized tests of memory, processing speed, verbal fluency and executive function, and also calculated an overall thinking score from available test results.

Over an average 12.3 years of follow-up, 572 participants had a first stroke, or slightly more than 10% of the study group. Among participants aged 60 to 69, those with lower overall thinking scores had an estimated 86% higher stroke risk than those with the highest scores. Lower memory scores were associated with a 68% higher risk, and lower processing-speed scores with a 66% higher risk.

The researchers grouped cognitive performance into low, middle and high categories within age groups. Stroke events were identified through Sweden’s National Patient Register of specialized inpatient and outpatient care. The reported percentages describe comparisons between score groups in this study; they do not predict an individual’s personal likelihood of having a stroke.

Why the 60s Association Matters

The findings suggest that cognitive test results in a person’s 60s may be relevant to research and assessment of later stroke risk. If replicated, such results could help researchers identify people whose brain and vascular health merit closer attention. The study does not establish that cognitive tests should be used on their own to screen for stroke, nor does it show that improving a test score would prevent one.

The age difference is central to interpreting the result: the observed link appeared in the 60-to-69 group, not in participants aged 70 and above after adjustment. Lead author Alice Askemyr said the team examined separate age spans because older adults differ in health conditions and medication use. The result should not be read as evidence that cognition stops mattering after age 70; it is a finding about this sample and analysis.

Elisabeth Breese Marsh, a neurologist who was not involved in the study, said the findings add to discussion of managing vascular risk factors and supporting brain health before older age. That is expert interpretation, not a tested outcome of this research: the study did not assess whether a particular prevention program changed cognition or stroke incidence.

How Researchers Tracked Stroke Risk

Participants entered the Good Aging in Skåne project at age 60 or older; 46% were men. Health information was collected between 2001 and 2023, and the study combined project data with records from Sweden’s Board of Health and Welfare. Researchers compared later first-stroke events with participants’ cognitive-test performance at assessment.

Askemyr proposed one possible explanation for the pattern: lower scores in people in their 60s might sometimes reflect an earlier, undetected brain injury that could also relate to later stroke. She referred to such injuries as “silent” brain injuries. The study did not establish that this mechanism explains the association, and it did not show that participants with lower scores had such injuries.

The work is an observational study, not a trial. It can identify associations across a group over time, but it cannot determine whether lower cognitive performance contributes to stroke, whether underlying health factors contribute to both, or whether another explanation is involved.

“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

Limits of the Age-Specific Finding

The study cannot show that lower cognitive scores cause stroke. Although researchers accounted for other health and lifestyle factors, unmeasured or incompletely measured differences may still help explain the association. The proposed role of silent brain injuries is a hypothesis, not a confirmed finding from this analysis.

The report does not provide enough detail to translate the relative risk estimates into an individual’s absolute risk or to determine how useful cognitive testing would be as a screening tool. It also remains unclear why the association appeared in the 60-to-69 group but not in older participants after adjustment.

Askemyr cautioned that results from a Swedish cohort may not apply in the same way to people in other countries, where healthcare, socioeconomic conditions and lifestyle differ. The findings also concern first strokes in people without a prior stroke, transient ischemic attack or dementia history at enrollment; they do not answer questions about recurrence or every patient group.

Replication and Prevention Research

The reported paper does not announce a follow-up trial or a planned next milestone. The findings will need to be tested in other populations to assess whether the age-specific association holds outside this Swedish cohort and whether cognitive scores add useful information beyond established stroke-risk measures.

Further research could also examine the possible links among cognitive performance, silent brain injuries and vascular health, while distinguishing association from cause. For readers, the study is not a diagnostic result or a reason to interpret a low test score as evidence that a stroke will occur. Decisions about personal stroke risk and health care should be discussed with a qualified health professional.

Key Questions

What did the Swedish study find?

Among adults aged 60 to 69, lower scores in overall thinking, memory and information-processing speed were associated with a higher risk of first stroke during follow-up. The same pattern was not observed among participants aged 70 to 79 or 80 and older after adjustment for other factors.

How many participants had a stroke?

Of 4,912 participants, 572 had a first stroke during an average 12.3 years of follow-up. That is slightly more than 10% of the study group.

Does the research show that lower cognition causes stroke?

No. The study was observational and found an association, so it cannot establish cause and effect. Researchers also did not confirm why the link appeared in the youngest age group studied.

Can cognitive scores predict an individual’s stroke risk?

The reported results compare groups in this study and do not provide a personal risk prediction. The research does not establish cognitive testing as a stand-alone stroke screening method.

Do the results apply to people outside Sweden?

That is uncertain. The study authors noted that differences in healthcare, socioeconomic conditions and lifestyle could affect how well the findings apply elsewhere.

Source: rss