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In a Swedish study of 4,912 adults aged 60 and older, lower scores in overall thinking, memory and processing speed were associated with higher first-time stroke risk among participants aged 60–69. The pattern was not seen among older age groups after adjustment for health and lifestyle factors, and the observational study cannot show that lower scores caused strokes.
Lower cognitive test scores among adults aged 60–69 were associated with a higher risk of a first stroke years later in a Swedish study published September 30 in the Journal of the American Heart Association. The association involved overall thinking ability, memory and information-processing speed; the researchers did not find the same pattern among participants aged 70 and older after accounting for other factors.
The study followed 4,912 adults aged 60 and older who had no history of dementia, stroke or transient ischemic attack when they enrolled in the Good Aging in Skåne project. Participants completed standardized tests assessing memory, processing speed, verbal fluency and executive function. Researchers combined available test results to estimate overall thinking ability and grouped scores into low, middle and high ranges within age groups.
During an average 12.3 years of follow-up, 572 participants had a first stroke, according to records from Sweden’s National Patient Register. Among participants aged 60–69, those in the lowest score groups had an estimated 86% higher risk of stroke for overall thinking ability, 68% higher risk for memory and 66% higher risk for processing speed, compared with those with the highest scores. These are relative risk estimates reported by the study, not absolute probabilities for an individual.
The study examined participants aged 60–69, 70–79 and 80 or older separately. After adjustment for other health and lifestyle factors, the association between lower scores and stroke risk was not seen in the two older groups. The researchers collected data from 2001 to 2023; participants were 46% men. The paper was led by researchers in Sweden and published in the American Heart Association’s open-access, peer-reviewed journal.
Cognitive Scores May Flag Midlife Risk
The findings raise the possibility that cognitive test results in a person’s 60s could help identify people who may warrant closer attention to stroke risk factors. They do not establish that a lower score itself raises stroke risk, or that changing a score would prevent a stroke. Cognitive performance and stroke may share underlying contributors, including vascular health or brain injury, and this study cannot determine which explanation accounts for the association.
Elisabeth Breese Marsh, a neurologist at Johns Hopkins University who was not involved in the research, said the findings support attention to vascular risk factors and brain health before older age. She said the study could point to a potential screening factor, while emphasizing that researchers do not know whether cognitive impairment itself further increases stroke risk. The results may be relevant to discussions about brain health, but they do not provide an individual diagnosis or prediction.
How Researchers Compared Age Groups
The Good Aging in Skåne project enrolled adults aged 60 and older in southern Sweden. Researchers linked participants’ health information with national records to identify first-time strokes during follow-up. They compared later stroke incidence among people with low, middle and high cognitive scores, analyzing age spans separately because health profiles can differ substantially across older adulthood.
Lead author Alice Askemyr, a geriatrics researcher at Lund University and Skåne University Hospital, said factors associated with risk may differ by age. She noted that people in their 80s often have multiple medical conditions and take several medications, while many people in their 60s may have fewer such factors. The study’s age-specific comparisons describe associations in this Swedish cohort; they do not establish that age alone explains why the pattern differed.
““So-called ‘silent’ brain injuries can affect both cognitive functioning and the future risk of stroke.””
— Alice Askemyr, M.D., lead author and geriatrics researcher
Cause and Wider Applicability Remain Open
The research was observational, so it cannot show that lower cognitive performance causes stroke. The association could reflect shared causes, including health conditions or prior brain injury that was not detected. Askemyr said so-called silent brain injuries may affect both cognition and later stroke risk, but that possibility was not demonstrated as the cause of the study’s findings.
The researchers also cautioned that results from a Swedish population may not apply in the same way elsewhere, given differences in health care, socioeconomic conditions and lifestyle. The reported risk estimates compare score groups within the study; they do not show a person’s absolute chance of stroke. It also remains unclear why the association appeared among adults in their 60s but not among older participants after adjustment.
Further Research Must Test the Link
The study does not report a planned follow-up trial or a change to clinical screening guidance. Further research would be needed to determine whether cognitive scores add useful information to established stroke risk assessments, whether the age-specific pattern appears in other populations, and what factors may explain it. The next evidence to watch for is independent research that tests the findings beyond this Swedish cohort.
Key Questions
What did the Swedish study find?
Among adults aged 60–69, 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 pattern in participants aged 70 and older after adjustment for other factors.
Does a lower cognitive score cause stroke?
No cause was established. The study was observational and found an association; it cannot show whether lower scores contribute to stroke risk, reflect shared underlying factors, or relate to another explanation.
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, according to Swedish National Patient Register data.
Do the percentages describe an individual’s chance of stroke?
No. The 86%, 68% and 66% figures are relative risk estimates comparing lower and higher cognitive score groups among participants aged 60–69. They are not an individual’s absolute probability of having a stroke.
Source: rss
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