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A Swedish observational study of 4,912 adults found that lower scores on several cognitive tests among people ages 60 to 69 were associated with higher risk of a first stroke over an average 12.3 years. The same pattern was not seen among participants age 70 or older after researchers accounted for health and lifestyle factors; the study cannot show that lower scores cause strokes.
A Swedish study found that adults ages 60 to 69 who scored lower on tests of thinking, memory and information-processing speed had a higher risk of a first stroke over the following years. The research, published in the Journal of the American Heart Association, followed 4,912 adults and found that the association did not appear in participants age 70 or older after adjustments for health and lifestyle factors.
Researchers followed adults enrolled in the Good Aging in Skåne project, with health data collected from 2001 through 2023. Participants were at least 60 at enrollment, and 46% were men. They had no recorded history of dementia, stroke or transient ischemic attack, sometimes called a mini-stroke, when they completed the cognitive assessments. The tests covered memory, processing speed, verbal fluency and executive function, among other skills. Researchers grouped scores as low, middle or high within age groups and used the available tests to estimate overall thinking ability.
During an average 12.3 years of follow-up, 572 participants had a first stroke, just over 10% of the study group. Researchers identified events using Sweden’s National Patient Register for specialized inpatient and outpatient care. Among participants ages 60 to 69, lower overall thinking scores were associated with an 86% higher stroke risk than the highest scores. 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 comparisons between participants with the lowest and highest scores in the relevant measures, as reported by the study. The study did not establish that any cognitive score predicts an individual’s future stroke, nor did it test whether screening based on these scores would prevent strokes. Researchers said the age-specific pattern was not seen for people ages 70 to 79 or 80 and older after adjustment for other health and lifestyle factors.
A Possible Midlife Risk Signal
The findings add to questions about whether changes in cognitive performance during midlife could help identify people who may have elevated vascular risk. If the association is reproduced in other populations, cognitive testing might offer researchers another factor to examine alongside established health and lifestyle measures. The study itself did not evaluate a screening program or show that acting on a low score changes stroke outcomes.
Lead author Alice Askemyr, a geriatrics researcher at Lund University and Skåne University Hospital, said that a lower score among people in their 60s could reflect an undetected brain injury or other influences on cognition. The researchers also raised the possibility that cognitive impairment itself might relate to future stroke risk, but said that the study cannot determine whether that is the case. For readers, the practical point is limited: the results support further study of midlife brain and vascular health, not a diagnosis based on a test score.
Elisabeth Breese Marsh, a neurologist at Johns Hopkins who was not involved in the study, said people should focus on modifying risk factors and habits associated with overall brain health earlier in life. Her comments are guidance from an outside specialist, rather than a finding tested by this research. The study did not identify which specific actions, if any, account for the association it observed.
How Age Shaped the Results
The study examined different age spans because health profiles can vary considerably among older adults. Askemyr said people in their 60s may have fewer medical conditions than people in their 80s, who may also take multiple medications. That variation can affect both cognitive test performance and the relationship researchers observe between test scores and later health events.
The researchers proposed that some participants in their 60s with lower scores might already have had unrecognized brain injury. Askemyr said so-called silent brain injuries can affect cognitive functioning and future stroke risk. She cited estimates that such injuries affect roughly 70% of adults over 70, suggesting their effects may be harder to distinguish in older groups where other health conditions and medications are more common. This is a possible explanation offered by the study’s lead author, not a cause established by the research.
The results come from an observational study, which tracks associations without assigning participants to an intervention. Participants’ scores and later stroke events were analyzed, but the design cannot show that lower cognitive performance caused a stroke or that raising a score would lower risk. The study authors also cautioned that findings from one Swedish population may not apply directly to people in countries with different health care systems, socioeconomic conditions and lifestyle patterns.
““We chose to investigate different age spans because the older population is very diverse.””
— Alice Askemyr, lead study author
Cause and Screening Remain Open
The research does not show whether lower cognitive scores contribute to stroke risk, result from an earlier brain injury, or reflect other factors shared by people who later had strokes. Although researchers adjusted for health and lifestyle factors, an observational analysis cannot rule out every possible explanation. The report also does not establish why the association appeared in the 60-to-69 age group but not in older participants.
It is not yet clear whether cognitive testing could reliably identify people at greater risk in routine care, what score would be useful for that purpose, or whether using such a test would improve outcomes. The study reported results from people in one Swedish project, so whether the same pattern holds in other countries and populations remains uncertain. No individual risk estimate or clinical recommendation can be drawn from the reported percentages alone.
Further Studies Needed
The published study reports results from the Swedish cohort; the source material does not specify a planned follow-up study or a date for further findings. Researchers would need to examine whether the age-specific association appears in other populations and whether it persists when cognitive tests, health conditions and stroke events are assessed in comparable ways.
Additional research could also investigate whether cognitive scores add useful information to existing approaches for understanding stroke risk, and whether any resulting screening strategy benefits patients. Until such evidence is available, the findings remain an association from one observational study. Marsh’s comments encourage attention to risk factors and brain health, but the study did not assess a particular prevention plan.
Key Questions
What did the Swedish study find?
Among adults ages 60 to 69, lower scores on tests of overall thinking, memory and processing speed were associated with higher risk of a first stroke during follow-up. Researchers did not observe the same pattern among participants age 70 or older after adjustments for health and lifestyle factors.
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. Stroke events were identified through Sweden’s National Patient Register for specialized inpatient and outpatient care.
Does the study show that lower cognitive scores cause strokes?
No. The study was observational, so it found an association but cannot establish that lower scores cause strokes. The researchers said undetected brain injury or other factors could help explain the result.
Do the findings apply to people in other countries?
That is not known. The study involved participants in a Swedish project, and its lead author said differences in health care, socioeconomic conditions and lifestyle may limit how directly the results apply elsewhere.
Source: rss
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