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Dementia after stroke: the Framingham Study
Ivan CS, Seshadri S, Beiser A, Au R, Kase CS, Kelly-Hayes M, Wolf PA.. Stroke, 2004-04-29
Topic: Risk, prevention and care in population studies
Background and purpose Identification of risk factors for dementia after stroke is best performed in comparison with stroke-free controls, because older subjects at high risk for stroke also have a substantial risk of dementia in the absence of stroke. Previous case-control studies were hospital-based. We used a nested case-control design to prospectively evaluate these risk factors in the community-based Framingham Study cohort. Methods We compared 212 subjects who were free of dementia in January 1982 and sustained a first stroke after this date, with 1060 age- and sex-matched, stroke- and dementia-free controls. We calculated 10-year risks of dementia (by Diagnostic and Statistical Manual of Mental Disorders, Volume IV criteria) developing in cases and controls and also estimated the hazard ratios within subgroups defined by exposure to various demographic factors (age, gender, education), stroke-related features (right or left hemisphere, stroke type, second stroke), stroke risk factors (hypertension, diabetes, atrial fibrillation, smoking) and apolipoprotein E genotype. Results Dementia developed in 19.3% of cases and 11.0% of controls. Baseline stroke doubled the risk of dementia (hazard ratio [HR]: 2.0; 95% confidence interval [CI]: 1.5 to 3.1) and adjustment for age, sex, education, and exposure to individual stroke risk factors did not diminish the risk (HR: 2.4; 95% CI: 1.6 to 3.7). The HR was higher in younger subjects (age younger than 80 years [HR: 2.6; 95% CI: 1.5 to 4.5]), apolipoprotein E 3/3 homozygotes (HR: 3.4; 95% CI: 2.0 to 5.8), and high school graduates (HR: 2.4; 95% CI: 1.5 to 3.9). Conclusions Stroke increases a subject's risk of dementia as compared with age- and sex-matched controls. Primary and secondary prevention of stroke should significantly decrease the risk of all dementia.
Key findings
- Results Dementia developed in 19.3% of cases and 11.0% of controls.
- Conclusions Stroke increases a subject's risk of dementia as compared with age- and sex-matched controls.
- Primary and secondary prevention of stroke should significantly decrease the risk of all dementia.
Why it matters
In the community-based Framingham Study, stroke doubled the risk of dementia compared with age- and sex-matched controls, and dementia developed in 19.3% of cases versus 11.0% of controls. The authors conclude that primary and secondary prevention of stroke should significantly decrease the risk of all dementia, which is a prevention implication rather than a treatment or cure.
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Study details
- Study designcase-control study
- Participants212
- Effect size19.3%; 11.0%; HR: 2.4
- Evidence strengthModerate
How this study scored 63/100
Published in a peer-reviewed journal, and it is a case-control study. Scored zero for randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Stroke) |
| Journal's citation record | 3 / 4 | Stroke: journal h-index 455 (OpenAlex, 2026-10-29) |
| Study design | 6 / 12 | A case-control study |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2004 — older than 20 years, still counted |
| Sample size | 2 / 4 | 212 participants |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 6 / 7 | Cited 370 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 15.4 citations a year over 24 year(s) since 2004 |
| Impact for its field and year | 4 / 6 | Cited 12.2× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 3 / 6 | Cited by 28 other studies in this library |
| Still being cited | 2 / 4 | Cited 39 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 4 / 4 | Last-listed author Philip A. Wolf: h-index 149 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Boston University: institution h-index 1,456 (OpenAlex) |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 15118167) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 63 / 100 | — |
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Read the original
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record names 7 authors; APA and Vancouver show the first six, BibTeX and the downloads carry all of them. Check the citation against the original before you use it.
APA 7th
Ivan, C. S., Seshadri, S., Beiser, A., Au, R., Kase, C. S., Kelly-Hayes, M., et al. (2004). Dementia after stroke: the Framingham Study. Stroke. https://doi.org/10.1161/01.str.0000127810.92616.78
Vancouver
Ivan CS, Seshadri S, Beiser A, Au R, Kase CS, Kelly-Hayes M, et al. Dementia after stroke: the Framingham Study. Stroke. 2004. doi:10.1161/01.str.0000127810.92616.78. PMID: 15118167.
BibTeX
@article{ivan2004-15118167,
author = {Ivan, C. S. and Seshadri, S. and Beiser, A. and Au, R. and Kase, C. S. and Kelly-Hayes, M. and Wolf, P. A.},
title = {{Dementia after stroke: the Framingham Study}},
journal = {Stroke},
year = {2004},
doi = {10.1161/01.str.0000127810.92616.78},
pmid = {15118167},
url = {https://doi.org/10.1161/01.str.0000127810.92616.78}
}
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