Signs of stroke may appear ‘10 years before incident occurs’

Women and APOE gene carriers, which is linked to Alzheimer’s disease, at higher risk

The signs of a stroke may appear up to 10 years before the actual stroke itself occurs, according to new research.

A study from the Netherlands has found that stroke patients experienced a much steeper decline in cognitive skills and routine daily functioning up to a decade before their stroke, compared to their peers who did not have a stroke.

Women, carriers of the APOE gene that is associated with Alzheimer’s disease, and those with fewer academic qualifications seemed to be at greater risk.

The researchers used various cognitive ability tests on 14,712 Rotterdam Study participants between 1990 and 2016.


These tests examined memory, mental processing, verbal fluency, reaction times, and manual dexterity.

Participant’s capacity to carry out tasks associated with independent daily living, such as washing, eating, and dressing were also examined, as was more advanced activities such as managing finances.

The researchers then checked the participants’ medical records to monitor their health until 2018.

Each person who had a stroke during the monitoring period was matched with three people who hadn’t, based on their age and sex.

The researchers then plotted the changes in cognition and daily functioning in both sets of participants, to include 10 years before the stroke and 10 years after.

During an average monitoring period of 12½ years, 1,662 participants had their first ever stroke. Their average age was 80.

Analysis of the participants’ test scores revealed clear differences in cognitive function between those who had a stroke and those who didn’t, as far back as ten years before the event.

Stroke patients

Cognition and daily functioning were lower in those who had a stroke, and differences in test scores were observed years before any stroke occurred.

“Our findings demonstrated that future stroke patients start to deviate from stroke-free controls up to 10 years before the acute event, suggesting that individuals with cognitive and functional decline are at a higher risk of stroke and are possible candidates for prevention trials,” the research paper states.

“The accelerated decline in cognition and daily functioning before stroke suggests that individuals with future stroke suffer from accumulating intracerebral damage years before the acute event, such as cerebral small vessel disease, neurodegeneration, and inflammation.”

Sixty per cent of those who had a stroke were women.

APOE gene carriers and those with fewer academic qualifications were also more at risk.

This observational study was published online in the Journal Of Neurology Neurosurgery & Psychiatry.