Increased risk of stroke in highly educated individuals with self-reported memory complaints


Literature - Sajjad A et al., Stroke 2015

Subjective Memory Complaints and the Risk of Stroke

Sajjad A, Mirza SS, Portegies MLP, et al.
Stroke. 2015;46:00-00. DOI: 10.1161/STROKEAHA.114.006616
 Lower performance on objective cognitive tests has been related to a higher risk of stroke [1]. Self-reported memory complaints may, however, constitute an earlier indicator of stroke.
Cognitive impairment and stroke may be linked through a shared pathogenesis. For instance, vascular risk factors for stroke are also determinants of cognitive impairment and dementia [2,3]. Early vascular damage may be manifested early as subjective memory complaints and followed later by clinical stroke. Subjective memory complaints in highly educated individuals may be a better marker than cognitive testing to assess vascular brain injury. Highly educated individuals probably have better abilities to mask subtle impairments during cognitive testing.
This population-based studyinvestigated the association between self-reported memory complaints and stroke, and whether this is influenced by educational level. To this end, 9152 participants from  the Rotterdam study completed the subjective memory complaints questionnaire and underwent the Mini-Mental State Examination (MMSE). The total cohort, with a mean age of 67, was subsequently followed for incident stroke during a mean follow up of 12.2 years.

Main results

  • 1134 strokes were identified (663 ischemic and 99 hemorrhagic).  
  • The presence of subjective memory complaints was independently associated with an increased risk of stroke (HR: 1.20, 95%CI: 1.04–1.39).
  • A higher Mini-Mental State Examination score was not associated with a higher risk of stroke (HR: 0.99, 95%CI: 0.95–1.02).
  • Subjective memory complaints were significantly associated with stroke only in individuals with high education (HR: 1.39, 95%CI: 1.07–1.81)
  • The time to incident stroke was shorter in individuals with a high education level who reported memory complains than those without subjective memory complaints (see figure).


Subjective memory complaints might be an early indicator of stroke risk, especially in highly educated individuals, while scores on objective cognitive tests were not associated with stroke risk. Highly educated individuals with subjective memory complaints should be a primary target for further risk factor screening and prevention of stroke.

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1. Rostamian S, Mahinrad S, Stijnen T, et al. Cognitive impairment and risk of stroke: a systematic review and meta-analysis of prospective cohort studies. Stroke. 2014;45:1342–1348.
2. Sahathevan R, Brodtmann A, Donnan GA. Dementia, stroke, and vascular risk factors; a review. Int J Stroke. 2012;7:61–73.
3. Iadecola C. The overlap between neurodegenerative and vascular factors in the pathogenesis of dementia. Acta Neuropathol. 2010;120:287–296.

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