Study Finds Lower Cognitive Scores in 60s Linked to Higher Stroke Risk

By douglasharrington // 2026-10-11

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An observational study published in September in the Journal of the American Heart Association examined whether adults ages 60 to 69 with lower cognitive test scores were more likely to experience a stroke later in life, according to the study. The study followed 4,912 participants, including 3,094 ages 60 to 69, who had no prior dementia, stroke, or transient ischemic attack (TIA) at enrollment. After an average follow-up of 12.3 years, 572 participants experienced a stroke. Researchers found that participants ages 60 to 69 who scored lower on certain cognitive tests had up to an 86% increased risk of stroke, the study stated. According to the American Heart Association, lower overall thinking ability was linked to an 86% higher risk of stroke, while lower memory scores and slower processing speed were also associated with elevated risk. Stroke occurs every 40 seconds in the United States, according to the Centers for Disease Control and Prevention (CDC), and risk increases with age. A growing body of research has connected vascular health to brain health, including studies showing that modifiable risk factors such as high blood pressure, diabetes, and smoking in midlife are linked to dementia risk later in life.

Details of the Study and Key Findings

In participants aged 60 to 69, the study found an 86% higher risk of stroke in those with lower overall thinking ability, a 68% higher risk in those with reduced episodic memory, and a 66% higher risk in those with slower information processing, according to the researchers. Episodic memory refers to the ability to recall specific events and experiences. Among all participants, there was no increase in stroke for those with lower scores compared with the mid-scoring group for verbal fluency and selected components of executive function, the study stated. Executive function includes skills such as planning, organizing, and completing tasks. The researchers did not find any significant associations in participants ages 70 and older after adjusting for health and lifestyle factors such as smoking status, alcohol consumption, physical activity levels, diabetes, and ischemic heart disease, according to the study. Ischemic heart disease is a condition characterized by reduced blood flow to the heart. The study authors suggested that individuals with lower cognitive scores might have had more silent strokes, which do not cause obvious symptoms, than those with higher scores. Silent strokes, also known as silent cerebral infarctions, are areas of brain tissue damage that can occur without the person realizing they have had a stroke. Previous research has examined how such subclinical cerebrovascular disease may affect cognitive function. A study on cerebral small vessel disease reported that reduced N-acetylaspartate levels are consistent with axonal dysfunction [1].

Experts Discuss Possible Mechanisms

Derk W. Krieger, MD, PhD, professor of neurology and consultant neurologist at Re: Cognition Health, told Medical News Today that the age-specific finding may reflect the period when subclinical cerebrovascular disease becomes sufficiently prevalent to affect cognition, while cognitive impairment is still relatively sensitive to vascular brain injury rather than advanced age alone. Krieger was not involved in the study. Krieger said the stronger association with memory and processing speed is biologically plausible because these functions depend on distributed neural and white-matter networks that are vulnerable to small-vessel disease and silent cerebrovascular injury, while verbal fluency and executive function are more influenced by education, language, cognitive reserve, and compensatory mechanisms. Christopher Yi, MD, board-certified vascular surgeon at MemorialCare Orange Coast Medical Center, told MNT that silent cerebral infarctions and small-vessel disease can occur without obvious stroke symptoms but may still affect cognitive function and increase the risk of a future clinical stroke; however, the study did not use MRI to confirm that mechanism. Yi was not involved in the study. Krieger agreed that it is plausible individuals with lower cognitive scores may have experienced more silent cerebrovascular events, but said it remains unproven unless supported by neuroimaging or longitudinal evidence. Yi said shared risk factors such as hypertension, diabetes, smoking, and physical inactivity can damage the blood vessels supplying the brain and contribute to both cognitive decline and stroke, and the association persisted in the 60 to 69 group even after adjusting for many of these risk factors. Research has consistently identified shared vascular risk factors for cognitive impairment and stroke. A study examining incident cognitive impairment in the Stroke Belt region noted that hypertension, diabetes, kidney disease, and metabolic syndrome are precursor or concomitant risk factors for both stroke and cognitive impairment [2]. Other research has examined how markers of inflammation relate to cognitive decline in specific populations [3].

Cognitive Testing and Stroke Risk Assessment

Current stroke risk assessments typically involve evaluating blood pressure, blood sugar, body mass index, blood cholesterol, physical activity, tobacco use, typical diet, existing conditions such as diabetes and atrial fibrillation, and personal family history of stroke, TIA, or heart attack, according to the study. Atrial fibrillation is an irregular heart rhythm that can increase stroke risk. The study authors suggest that cognitive testing could be an important screening tool for future stroke in younger older adults, the report stated. This suggestion reflects growing interest in identifying early markers of cerebrovascular disease before clinical events occur. Krieger cautioned that cognitive testing should not yet be considered a routine component of stroke-risk assessment, saying this would require replication, demonstration of predictive value beyond established vascular risk scores, and evidence that acting on cognitive-test results improves clinical outcomes. Yi agreed that it is too early to recommend cognitive testing specifically for stroke prediction, and said future studies will need to determine whether cognitive testing adds meaningful information beyond established risk factors such as hypertension, diabetes, smoking, cholesterol, and atrial fibrillation; he added it may eventually be most useful when combined with imaging or other biomarkers. Yi concluded that the main takeaway is that brain health and vascular health are closely connected, but the study demonstrates an association and does not prove that lower cognitive function itself causes stroke. The distinction between association and causation is central to interpreting observational research. Studies examining cognitive performance after stroke have similarly noted that stroke among dementia-free individuals may be followed by poor cognitive performance in multiple domains [4].

References

Reduced N-acetylaspartate is consistent with axonal dysfunction in cerebral small vessel disease by John Wiley. Journal of Neurochemistry Wiley & Sons Ltd 2008
Incident Cognitive Impairment is Elevated in the Stroke Belt: The REGARDS Study. ANN NEUROL 2011;70:229–236
Markers of inflammation and cognitive decline in an African-Caribbean population by John Wiley. Journal of Clinical Neuroscience
Cognitive Performance after Stroke – The Framingham Heart .... https://pmc.ncbi.nlm.nih.gov/articles/PMC4215163/

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