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New Risk Assessment Tool May Help Predict Dementia After A Stroke

Research Highlights:

  • A new risk prediction tool was able to accurately identify stroke survivors with the highest risk for developing dementia within a decade of having a stroke, according to a large study in Canada.
  • Factors linked with a higher risk of developing dementia after a stroke included being older, having any disability before the stroke, having a higher level of disability after the stroke, having an intracerebral hemorrhage (compared to an ischemic stroke), having diabetes, experiencing cognitive symptoms during hospitalization or suffering from depression.
  • Knowing the risk of developing dementia after a stroke can help researchers design better clinical trials and interventions. It can also guide the recruitment of patients who are eligible to participate in efforts to lower the risk of dementia.
  • Note: The study featured in this news release is a research abstract. Abstracts presented at the American Heart Association/American Stroke Association’s scientific meetings are not peer-reviewed, and the findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

Embargoed until 4 a.m. CT/5 a.m. ET, Thursday, Jan. 29, 2026

According to researchers, people with stroke and transient ischemic attack (TIA) are at high risk of subsequent dementia, but prediction tools for dementia are lacking.

“Our previous research found that about 1 in 3 adults developed dementia after stroke over the long-term. We created a new tool that can stratify people into five different levels of dementia risk after stroke based on underlying health, stroke characteristics and risk factors,” said lead study author Raed A. Joundi, M.D., D.Phil., M.Sc., an assistant professor in the department of medicine at McMaster University, a stroke neurologist at Hamilton Health Sciences, a scientist at the Population Health Research Institute, all in Hamilton, Ontario, Canada, and an adjunct scientist at ICES Central in Toronto (where the statistical analysis was done).

“The goal is to have a practical, bedside tool that can predict dementia risk after a stroke. Our tool predicts dementia rates that are very close to the observed rates and may help to enroll high-risk patients who have had transient ischemic attack, ischemic stroke or intracerebral hemorrhage in clinical trials that are focused on reducing the long-term risk of dementia.”

Researchers examined health records for nearly 50,000 adults hospitalized with stroke to create and validate a risk model to estimate which stroke survivors have the highest risk of developing dementia. The data from the Ontario Stroke Registry included hospital admissions due to stroke between 2002 and 2013 in Canada. Study participants drawn from the registry for derivation of the risk score included 7,554 adults with transient ischemic attack (TIA), 13,833 with ischemic stroke and 2,340 with intracerebral hemorrhage. The participants were discharged from the hospital without a diagnosis of dementia, and all were followed for a diagnosis of dementia through March 2024 (average of 7.5 years after stroke) based on administrative health data.

Researchers examined the rates of dementia calculated by the new tool and compared them to the observed rates of dementia. The score was derived in the Ontario Stroke Registry (11 regional stroke centers) and validated in the Ontario Stroke Audit, a separate, randomly selected sample of patients from all hospitals in the province.

The analysis found:

  • For people who had a transient ischemic attack, the top factors associated with increased dementia risk were older age, needing help with activities of daily living prior to TIA, having diabetes, depression, cognitive symptoms on presentation (such as memory, judgment or attention) and any disability at hospital discharge.
  • The main risk factors associated with developing dementia for people with stroke were being older, being female, having diabetes, depression, intracerebral hemorrhage (compared to ischemic stroke), cognitive symptoms during hospitalization or greater disability at hospital discharge.
  • The risk calculator used the top risk factors for dementia to categorize individuals into different levels of estimated risk over the next 10 years after a stroke. Those in the highest category of estimated risk had a 50% probability of dementia over 10 years, versus participants in the lowest category of risk who had a 5% probability of dementia.

The study authors note that the current focus of the dementia risk prediction tool is to stratify patients into different levels of risk for research studies and clinical trials of dementia prevention, rather than clinical decision-making or treatment.

“Dementia is a serious condition that commonly occurs in the aftermath of a stroke,” Joundi said. “While our traditional focus has been on preventing another stroke, which is very important, we need to pay more attention to the development of dementia and how to prevent it. Over the long-term, dementia is more common than a recurrent stroke. Healthy lifestyle choices and controlling vascular risk factors can lower the risk of dementia, but we need new and effective targeted interventions for dementia prevention.”

Study limitations include that data were not available about the type of dementia that may develop. Researchers did not have access to imaging scans of the study participants, which would offer more detailed information about their stroke location and size or the presence of covert infarcts (small ischemic brain lesions).

American Stroke Association volunteer expert, Deborah A. Levine, M.D., M.P.H., said, “Dementia after a stroke is very difficult for patients and their loved ones, and there aren’t enough effective treatments to help. This well-done study provides a useful tool that could make research faster, so new treatments can get to stroke survivors sooner.” Levine is a professor of internal medicine and neurology, the departments of internal medicine and neurology, the Cognitive Health Services Research and Stroke Programs and the Institute for Healthcare Policy and Innovation at the University of Michigan. Levine was not involved in this study.

Study details, background and design:

  • The average age of all participants was 70; 53% of participants were men, and 47% women.
  • Using the new risk predictor tool, researchers calculated 1-, 5- and 10-year dementia risk scores, and participants were divided into five groups, ranging from the lowest to the highest risk, based on the risk factors that were present. The risk calculator evaluated the number and the degree of each factor’s contribution to dementia risk, resulting in a composite score that indicates the likelihood of developing dementia in the future.
  • Researchers identified risk factors and other characteristics, such as age, diabetes status, depression, disability and sex, then divided patients into five categories of dementia risk based on these risk factors.
  • To validate the results, researchers reviewed data on a similar number of stroke admissions from the Ontario Stroke Audit. Dementia risk scores were calculated separately for participants who had a transient ischemic attack vs. a stroke.
  • This tool, used prior to discharge from the hospital, has the potential to help physicians assess whether patients might develop long-term dementia.

Co-authors, disclosures and funding sources are listed in the abstract.

Statements and conclusions of studies that are presented at the American Heart Association/American Stroke Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

The Association receives more than 85% of its revenue from sources other than corporations. These sources include contributions from individuals, foundations and estates, as well as investment earnings and revenue from the sale of our educational materials. Corporations (including pharmaceutical, device manufacturers and other companies) also make donations to the Association. The Association has strict policies to prevent any donations from influencing its science content and policy positions. Overall financial information is available here.

Additional Resources:

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About the American Stroke Association

The American Stroke Association is a relentless force for a world with fewer strokes and longer, healthier lives. We team with millions of volunteers and donors to ensure equitable health and stroke care in all communities. We work to prevent, treat and beat stroke by funding innovative research, fighting for the public’s health, and providing lifesaving resources. The Dallas-based association was created in 1998 as a division of the American Heart Association. To learn more or to get involved, call 1-888-4STROKE or visit stroke.org. Follow us on Facebook and X.

For Media Inquiries and American Stroke Association Expert Perspective:

American Heart Association Communications & Media Relations: 214-706-1173, ahacommunications@heart.org

Karen Astle: Karen.Astle@heart.org

For Public Inquiries: 1-800-AHA-USA1 (242-8721)

heart.org and stroke.org

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