Lower cognitive test scores among adults in their 60s may signal higher future stroke risk
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Adults in their 60s who scored lower on tests of overall thinking ability, memory and how quickly they processed information were more likely to have a stroke years later, according to new research conducted in Sweden and published in the Journal of the American Heart Association.
The study examined the risk of first-time stroke among nearly 5,000 adults ages 60 to 80 and older, comparing cognitive test scores with later stroke incidence.
Study participants, all of whom had no history of dementia, stroke or transient ischemic attack (often known as a mini-stroke), completed tests measuring overall thinking ability, memory, processing speed, verbal skills and select problem-solving skills. During an average 12 years of follow-up, more than 10% of participants had a first-time stroke. Researchers then estimated stroke risk for those with the lowest cognitive function scores compared with those with the highest scores.
Among adults ages 60–69, the study found:
- Lower overall thinking ability was linked to an 86% higher risk of stroke;
- Lower memory scores were linked to a 68% higher stroke risk; and
- Lower information-processing speed scores were linked to a 66% higher risk of stroke.
The same pattern of cognitive scores and stroke risk was not seen among adults ages 70–79 or those 80 and older after researchers accounted for other health and lifestyle factors.
"We chose to investigate different age spans because the older population is very diverse. For instance, while many people in their 60s may have only a few medical conditions, people in their 80s often suffer from multiple medical conditions and take numerous medications," said lead study author Alice Askemyr, M.D., a geriatrics researcher at Lund University and Skåne University Hospital in Malmö, Sweden. "Furthermore, what serves as a risk factor in early life might not serve as one if it is acquired later in life and vice versa."
She also noted that poor cognitive performance among the younger study participants could indicate that they had already had an undetected brain injury. "So-called 'silent' brain injuries can affect both cognitive functioning and the future risk of stroke," Askemyr said. "They affect roughly 70% of adults over age 70, so their effects may be easier to detect among people in their 60s, when such injuries and other factors that can affect cognition, including medical conditions and medications, are less common."
Elisabeth Breese Marsh, M.D., FAHA, chair of the 2026 American Heart Association scientific statement Brain Health Across the Life Span: A Framework for Future Studies, was not involved in the study. "While it is certainly important for people in their 60s, my advice would be that even people in their 40s and 50s need to be focusing on risk factor modification and habits for good overall brain health," she said.
Marsh is a professor of neurology and director of the Bayview Stroke Center at The Johns Hopkins University School of Medicine in Baltimore.
"This study, in conjunction with others, supports how important it is to be aggressive in managing vascular risk factors and focusing on brain health in midlife, before many people typically begin to think about it. This would improve both cognitive performance and stroke risk in older age," she added. "However, because we don't know for sure if there is something about the cognitive impairment itself that further increases risk of stroke, the study also provides a new potential screening factor to identify those with higher stroke risk."
According to the American Stroke Association, a division of the American Heart Association, overall health, lifestyle and environment can affect brain health and cognition over time.
Study details, background, design and limitations:
- The study included 4,912 adults ages 60 to 80 and older who enrolled in the Good Aging in Skåne project. It also included health data from the Swedish Board of Health and Welfare.
- Participants were ages 60 and older (46% men) at enrollment. Data were collected from 2001 to 2023.
- During an average follow-up period of 12.3 years, 572 participants had a stroke. Data on first-time strokes were drawn from the Swedish National Patient Register of specialized inpatient and outpatient care.
- Cognitive function was assessed using standardized tests of memory, processing speed, verbal fluency and executive function. Scores were combined and grouped by age into low, middle and high cognitive performance. Overall thinking ability was estimated as a composite of all available tests.
- The study was observational, meaning it found a link between lower cognitive test scores and stroke risk but cannot prove cause and effect.
The findings may not be generalizable to people living in other countries because of differences in health care, socioeconomic conditions and lifestyle habits, Askemyr noted.
Publication details
Lower Cognitive Function in People Aged 60 to 69 Years Is Associated With Future Stroke, Journal of the American Heart Association (2026). DOI: 10.1161/JAHA.125.048423
Journal information: Journal of the American Heart Association
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