Swedish Study Links Lower Midlife Cognitive Scores To Future Strokes

TL;DR

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A Swedish study of 4,912 adults found that among participants aged 60 to 69, lower scores in overall thinking, memory and processing speed were associated with higher risk of a first stroke during follow-up. The pattern was not seen in participants aged 70 and older after adjustment for health and lifestyle factors. Because the study was observational, it cannot establish that lower cognitive scores cause strokes.

A Swedish study found that adults aged 60 to 69 with lower scores on tests of thinking ability, memory and processing speed had a higher risk of a first stroke during follow-up than those with the highest scores. The association was not observed among people aged 70 and older after researchers accounted for other health and lifestyle factors; the observational study does not show that lower cognitive performance causes stroke.

The research, published in the Journal of the American Heart Association, included 4,912 adults aged 60 and older enrolled in the Good Aging in Skåne project in Sweden. Participants had no history of dementia, stroke or transient ischemic attack when assessed. They completed standardized tests of memory, processing speed, verbal fluency and executive function, with results combined into age-grouped performance categories.

Over an average 12.3 years of follow-up, 572 participants experienced a first stroke, according to records from Sweden’s National Patient Register. Among adults aged 60 to 69, the lowest 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, and lower processing-speed scores with a 66% higher risk.

Researchers did not find the same pattern among participants aged 70 to 79 or 80 and older after accounting for health and lifestyle factors. The study reports associations between test performance and subsequent stroke, not evidence that cognitive scores themselves predict an individual’s outcome or that changing a score would prevent a stroke.

Why Midlife Scores May Matter

The results add to research on how brain health and vascular health may be related, and suggest that cognitive test performance in people in their 60s could be relevant to future stroke-risk research. If replicated, such scores might help researchers identify patterns worth investigating alongside established health factors. The authors and outside expert quoted in the report do not present cognitive testing as a standalone screening tool or as a replacement for routine clinical assessment.

For readers, the age difference is a central part of the finding: the reported association appeared in the 60-to-69 age group, not in older groups after adjustment. That does not mean people over 70 are protected from stroke, or that lower cognitive scores in younger adults necessarily signal an impending event. The study cannot determine whether the relationship reflects an underlying brain or vascular condition, other influences, or some combination.

Elisabeth Breese Marsh, a neurologist at Johns Hopkins University who was not involved in the study, told News-Medical that people should focus on risk-factor management and habits supporting brain health before older age. Her comments are broader guidance, not a result tested by this study. The findings may inform future research into whether cognitive performance can contribute useful information to stroke-risk assessment.

How the Swedish Study Was Conducted

The analysis drew on the Good Aging in Skåne project and Swedish health data. Enrollment participants were at least 60 years old, and 46% were men. Data covered 2001 to 2023. Researchers assessed cognition at enrollment and compared test-score groups with later first-stroke events recorded in specialized inpatient and outpatient care registers.

Lead author Alice Askemyr, a geriatrics researcher at Lund University and Skåne University Hospital, said the team examined different age spans because health profiles vary among older adults. In the report, she noted that people in their 80s may have more medical conditions and use more medications than people in their 60s, and that a risk factor’s relevance may vary with age. This offers a possible reason to study age groups separately, but does not establish why the association differed.

Askemyr also raised the possibility that lower scores among younger participants could reflect an undetected brain injury. She said so-called silent brain injuries can affect cognition and future stroke risk. That is a proposed explanation, not something the study established as the mechanism behind its findings.

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

— Alice Askemyr, lead study author

Cause and Age Differences Remain Open

The study was observational, so researchers cannot conclude that lower cognitive performance causes stroke. The results also do not establish whether cognitive scores add predictive value beyond existing health information, or what might explain the absence of the same association in older groups after adjustment.

The findings come from adults in Sweden and may not apply in the same way elsewhere, Askemyr noted, because healthcare, socioeconomic conditions and lifestyle differ among countries. The report also does not establish that a cognitive test should be used to screen individuals for stroke risk. Further research would be needed to test that possibility and clarify whether silent brain injuries or other factors account for the results.

Further Research on Stroke Risk

The study does not announce a follow-up trial or a change to clinical screening. The next step is for researchers to test whether the age-specific association appears in other populations and to investigate the factors that could link cognitive performance with later stroke. Work would also need to establish whether cognitive testing offers useful information beyond established risk assessments.

For now, the finding is best read as a research association, not a diagnosis or a forecast for any one person. The study authors and the outside expert point to managing vascular risk factors and supporting brain health as relevant areas for attention, while the effect of any particular intervention was not evaluated in this analysis.

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 a first stroke during follow-up. The same pattern was not found in older age groups after adjustment for health and lifestyle factors.

How many people had a stroke during the study?

Of 4,912 participants, 572 experienced a first stroke during an average 12.3 years of follow-up, according to Swedish National Patient Register data.

Does the study show that low cognitive scores cause strokes?

No. It was an observational study, which can identify an association but cannot establish that lower scores cause stroke or explain the direction of the relationship.

Did the association apply to people over 70?

Researchers did not observe the same association among participants aged 70 to 79 or 80 and older after accounting for other health and lifestyle factors. This does not mean older adults are not at risk of stroke.

Could the findings apply outside Sweden?

That is not known. Lead author Alice Askemyr cautioned that differences in healthcare, socioeconomic conditions and lifestyle could limit how well the findings apply to people in other countries.

Source: rss