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Ischemic Stroke Incidence and Severity and Poststroke Cognitive Decline and Incident Dementia
Silvia Koton, Alden L. Gross, Hugo Javier Aparicio, Alexa S. Beiser, Emily M. Briceño, Josef Coresh, Mitchell S.V. Elkind, Bruno Giordani et al.. JAMA Network Open, 2026-04-16
Topic: Risk, prevention and care in population studies
A total of 42 342 participants from the pooled cohorts were included (mean [SD] age, 61.3 [9.8] years; 55.0% female). Longitudinal cognitive testing data were available for a median of 11.1 years (range, 0-29.7 years) with 397 344 person-years of observation for dementia incidence. Stroke severity data were available for 1055 of 1505 first-ever ischemic stroke survivors (70.1%). Compared with participants with no stroke, adjusted hazard ratios for incident dementia were 1.93 (95% CI, 1.52-2.45) for NIHSS 0 to 5, 3.26 (95% CI, 1.93-5.53) for NIHSS 6 to 10, and 5.06 (95% CI, 2.71-9.45) for NIHSS 11 or higher. Over the follow-up, higher stroke severity was associated with progressively steeper cognitive declines across all domains, with more prevalent dose-response associations for global cognition (ranging from a mean -0.18 [95% CI, -0.19 to -0.18] points per year for no stroke to -0.58 [95% CI, -0.73 to -0.42] points per year for moderate to severe stroke) and memory (ranging from a mean -0.15 [95% CI, -0.16 to -0.14] points per year for no stroke to -0.36 [95% CI, -0.51 to -0.21] points per year for moderate to severe stroke) than for executive function (ranging from a mean -0.33 [95% CI, -0.34 to -0.32] points per year for no stroke to -0.52 [95% CI, -0.66 to -0.39] points per year for moderate to severe stroke). Conclusions and Relevance: This large cohort study of participants from 3 prospective cohorts found that greater stroke severity was associated with substantially elevated dementia risk and accelerated decline in global cognition, memory, and executive function. These findings underscore the critical importance of stroke prevention, particularly severe stroke, and identifying mechanisms that may link stroke to cognitive decline.
Key findings
- A total of 42 342 participants from the pooled cohorts were included (mean [SD] age, 61.3 [9.8] years; 55.0% female).
- Longitudinal cognitive testing data were available for a median of 11.1 years (range, 0-29.7 years) with 397 344 person-years of observation for dementia incidence.
- Stroke severity data were available for 1055 of 1505 first-ever ischemic stroke survivors (70.1%).
- Compared with participants with no stroke, adjusted hazard ratios for incident dementia were 1.93 (95% CI, 1.52-2.45) for NIHSS 0 to 5, 3.26 (95% CI, 1.93-5.53) for NIHSS 6 to 10, and 5.06 (95% CI, 2.71-9.45) for NIHSS 11 or higher.
- Over the follow-up, higher stroke severity was associated with progressively steeper cognitive declines across all domains, with more prevalent dose-response associations for global cognition (ranging from a mean -0.18 [95% CI, -0.19 to -0.18] points per year for no stroke to -0.58 [95% CI, -0.73 to -0.42] points per year for moderate to severe stroke) and memory (ranging from a mean -0.15 [95% CI, -0.16 to -0.14] points per year for no stroke to -0.36 [95% CI, -0.51 to -0.21] points per year for moderate to severe stroke) than for executive function (ranging from a mean -0.33 [95% CI, -0.34 to -0.32] points per year for no stroke to -0.52 [95% CI, -0.66 to -0.39] points per year for moderate to severe stroke).
Why it matters
In this large cohort, more severe ischemic stroke was linked to progressively higher dementia risk and steeper cognitive decline across all domains in a dose-response pattern. It shows stroke severity matters for later cognitive outcomes but does not test any treatment or prevention.
Study details
- Study designcohort study
- Participants342
- Effect size55.0%; 70.1%
- Evidence strengthModerate
How this study scored 60/100
Published in a leading specialty journal, and it is a cohort study following people over time. Scored zero for randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (JAMA Network Open) |
| Journal's citation record | 2 / 4 | JAMA Network Open: journal h-index 235 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A cohort study following people over time |
| 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 | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 2 / 4 | 342 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| 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 | 1 / 7 | Cited 2 times (OpenAlex, 2026-10-10) |
| Citations per year | 1 / 5 | 1.0 citations a year over 2 year(s) since 2026 |
| Impact for its field and year | 4 / 6 | Cited 9.5× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 2 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Deborah A. Levine: h-index 43 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | Johns Hopkins University: institution h-index 2,306 (OpenAlex) |
| Multi-centre collaboration | 3 / 3 | OpenAlex lists 11 institution(s) in 2 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 41989779) |
| Free to read | 2 / 2 | Free to read |
| Total | 60 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
- DOI: 10.1001/jamanetworkopen.2026.8900
- PubMed: 41989779
- Original source →
- Free full text: JAMA Network Open →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
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's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
Koton, S., Gross, A. L., Aparicio, H. J., Beiser, A. S., Briceño, E. M., Coresh, J., et al. (2026). Ischemic Stroke Incidence and Severity and Poststroke Cognitive Decline and Incident Dementia. JAMA Network Open. https://doi.org/10.1001/jamanetworkopen.2026.8900
Vancouver
Koton S, Gross AL, Aparicio HJ, Beiser AS, Briceño EM, Coresh J, et al. Ischemic Stroke Incidence and Severity and Poststroke Cognitive Decline and Incident Dementia. JAMA Network Open. 2026. doi:10.1001/jamanetworkopen.2026.8900. PMID: 41989779.
BibTeX
@article{koton2026-41989779,
author = {Koton, Silvia and Gross, Alden L. and Aparicio, Hugo Javier and Beiser, Alexa S. and Briceño, Emily M. and Coresh, Josef and Elkind, Mitchell S.V. and Giordani, Bruno and others},
title = {{Ischemic Stroke Incidence and Severity and Poststroke Cognitive Decline and Incident Dementia}},
journal = {JAMA Network Open},
year = {2026},
doi = {10.1001/jamanetworkopen.2026.8900},
pmid = {41989779},
url = {https://doi.org/10.1001/jamanetworkopen.2026.8900}
}
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