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Study of Older Adults Ties Low Thinking Scores to Higher Stroke Risk, Mainly in Adults in Their 60s
In A Nutshell
- Swedish researchers tracked nearly 5,000 older adults for about 12 years.
- Low thinking, memory, and speed scores carried 66% to 86% higher stroke risk at ages 60 to 69.
- No clear link appeared in adults 70 and older.
- Results show an association, not proof that low scores cause strokes.
Adults ages 60 to 69 who landed in the bottom third on a set of thinking tests went on to have a stroke risk that reached nearly double that of those in the top third, according to a Swedish study in the Journal of the American Heart Association. Slow reactions or a shaky memory in those years are easy to brush off as ordinary aging. The new data hint that low scores may carry a medical warning worth investigating.
Researchers followed nearly 5,000 older adults for about 12 years, checking whether performance on tasks like recalling words or spotting matching patterns could predict who would later have a stroke. The link was clearest in people who were 60 to 69 at the start and mostly faded in those 70 and older.
Stroke was the third-leading cause of death worldwide in 2021, and doctors are always hunting for earlier warning signs that could start prevention conversations sooner. The authors wrote that cognitive testing “might be an important screening tool” for this age group.
Swedish Researchers Compared Thinking Test Scores and Stroke Risk Across Three Age Groups
Data came from Good Aging in Skåne, a long-running project in southern Sweden that randomly selected older adults from population records. Testing began in 2001, and national health records tracked strokes through the end of 2023.
Researchers analyzed 4,912 people with no history of stroke, mini-stroke, or dementia at the start, including 3,134 adults ages 60 to 69, 507 ages 70 to 79, and 1,271 who were 80 or older. Anyone with a past stroke or dementia was left out because those conditions can lower test scores on their own, which would muddy the question of whether low scores come first.
Participants took standard tests of memory (recalling and recognizing words), perceptual speed (how fast someone can spot and compare patterns), word fluency (how quickly someone can name animals and occupations), and a combined measure of working memory and mental flexibility. A fifth measure, overall thinking ability, averaged each person’s results across the tests. Within each age group, scores were sorted into thirds.
Over an average of 12.3 years, 572 of the 4,912 participants had a first stroke. The team compared the lowest-scoring third with the highest-scoring third on each measure, adjusting for age, sex, education, smoking, drinking, exercise, weight, blood pressure, cholesterol, diabetes, and heart disease. That showed whether the link held up after accounting for other factors tied to stroke risk.
Stroke Risk Rose for Low Scorers Ages 60 to 69, but Not Clearly for Older Adults
Across all ages combined, only one measure stood out: people in the bottom third for perceptual speed had a 40% higher stroke risk than those in the top third. Breaking the results down by age sharpened the pattern.
Among adults 60 to 69, 252 of 3,134 had a stroke over an average of 14.2 years. Those in the bottom third for overall thinking ability had an 86% higher risk than the top third. Low memory scores carried a 68% higher risk, and low perceptual speed a 66% higher risk. Word fluency, working memory, and mental flexibility showed no clear link.
No measure showed a significant increase in risk for adults ages 70 to 79 or those 80 and older in the final analysis, even though stroke becomes more common with age. Only 97 of 507 people ages 70 to 79 had a stroke, which limited what the analysis could detect.
Earlier research has found that stroke risk factors can act differently in men and women, so the team ran an exploratory look at the ages 60 to 69 group by sex. Men in the bottom third had a stroke risk 77% to 130% higher, depending on the measure. Women’s results pointed the same direction on some measures but were too uncertain to count as a firm finding, so those differences need confirmation.
Silent Brain Damage May Explain Why Low Scores Track With Stroke Risk
Tests like these may pick up quiet damage to the brain’s small blood vessels, the kind that causes no obvious symptoms but can come before a stroke. The authors raised that as a possible explanation and said brain-scan studies should test it. In older participants, more illnesses and deaths from unrelated causes may have drowned out the signal, and follow-up was shorter for those 80 and older, averaging 7.4 years.
Another possibility is that people with lower scores follow medical treatment less consistently, something the study could not measure. Either way, the study shows an association, not proof that low scores cause strokes.
A single forgetful moment is not a stroke forecast. Low scores on standardized testing in the early senior years are another matter, and this Swedish study gives researchers good reason to look closer. Brain scans and larger studies must come before testing becomes a screening tool.
Disclaimer: This article summarizes a published research study for general informational purposes and is not medical advice. Anyone with concerns about memory, thinking skills, or stroke risk should talk with a qualified health care professional.
Paper Notes
Limitations
Some test data were missing, and sorting scores into thirds likely lost finer detail. In the 70 to 79 age group especially, stroke events were few, which limited the ability to detect real differences. The statistical models included many adjustment factors, which raises the risk of overfitting in smaller subgroups, so results based on few events should be read with caution. The sex analysis was labeled exploratory by the authors. TIA (mini-stroke) was not counted as a stroke outcome, so some minor strokes may have been missed or misclassified, particularly because CT scans were the usual imaging method in Sweden during a large part of the study period. Participants in this kind of project are likely healthier than the general population, which may limit how broadly the findings apply, and data on the APOE4 gene variant, tied to Alzheimer disease risk, were not available. The paper also reports age-group counts for two slightly different samples (4,772 people with an overall thinking score and 4,912 overall); this article uses the full-cohort figures.
Funding and Disclosures
Good Aging in Skåne, the project that supplied the data, was supported by the Swedish Ministry of Health and Social Affairs, the County of Region Skåne, and the Swedish Research Council. The paper states the research received no specific grant from any other funding agency in the public, commercial, or not-for-profit sectors. The authors listed no disclosures.
Publication Details
“Lower Cognitive Function in People Aged 60 to 69 Years Is Associated With Future Stroke” was written by Alice Askemyr, MD; Rani Basna, PhD; Sölve Elmståhl, MD, PhD; and Marieclaire Overton, PhD, of the Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden. It appeared in the Journal of the American Heart Association, 2026;15:e048423 (received December 2, 2025; accepted August 3, 2026). DOI: 10.1161/JAHA.125.048423.
