Research News

Memory lapse in people with higher education can signal stroke risk, study finds

BMJ 2014; 349 doi: (Published 12 December 2014) Cite this as: BMJ 2014;349:g7604
  1. Susan Mayor
  1. 1London

Subjective reports of memory lapses are independently associated with an increased risk of stroke in people who are educated to university level, a follow-up study has found.1

“Studies have shown how stroke causes memory complaints,” explained Arfan Ikram, lead author and associate professor of neuroepidemiology at Erasmus University Rotterdam in the Netherlands. “Given the shared underlying vascular pathology, we posed the reverse question: ‘Do memory complaints indicate an increased risk of strokes?’”

To explore this question the research group studied 9152 people aged 55 and older who were taking part in the Rotterdam Study, a large prospective cohort study investigating risk factors for cardiovascular and other diseases in elderly people. Participants were recruited in 1990-93 or during an expansion of the cohort in 2000-01.

The study participants completed questionnaires on subjective memory complaints and took the Mini Mental State Examination (MMSE), which is commonly used to test memory and attention. They were then followed up for incident stroke by automatic linkage of GP files with the study database up to 2012. A total of 1134 strokes occurred, of which half (663) were ischaemic, 99 haemorrhagic, and 372 unspecified in type.

Analysis showed that subjective memory complaints were associated with a higher risk of stroke (hazard ratio 1.20 (95% confidence interval 1.04 to 1.39)), after adjusting for age, sex, and education, but that MMSE score was not. Ikram said that subjective memory complaints might occur earlier than the cognitive impairment associated with changes in MMSE score and thus may be an earlier marker of the vascular damage that could also lead to stroke.

People with memory lapses and a higher level of education—either university education or higher vocational training—had a 39% higher risk of stroke (1.39 (1.07 to 1.81)). This may be because they are more likely to notice subtle changes in their cognitive performance, Ikram said. Time to incident stroke was also shorter in people with higher education who had complained about their memory.

“We found that the association of memory complaints with stroke was strongest among people with the highest education,” reported Ikram. “If future research can confirm this, then I would like to assess whether people who complain about changes in their memory should be considered primary targets for further risk assessment and prevention of stroke.”


Cite this as: BMJ 2014;349:g7604


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