Memory gaps in graduates a 'stroke warning sign' | NICS Well (2023)

“People with memory problems who have a university education could be at greater risk of a stroke,” BBC News reports. The hypothesis is that the gaps in memory could be the result of reduced blood flow to the brain, which may then trigger a strokeat some point in the future.

Researchers documented memory complaints and occurrences of stroke in a group of 9,152 adults aged over 55 living in the Netherlands, for an average of 12.2 years.

This showed that replying “yes” to the question “Do you have any memory complaints” was associated with a 20% higher risk of stroke overall compared with those saying “no”. This relative risk was higher in people categorised as educated – holding a university degree or higher vocational qualification.

This shouldn’t be interpreted as meaning that having a higher education increases your risk of stroke. The explanation put forward by the experts was that people with a higher education may have higher levels of cognitive awareness, so they may be more likely to be aware of worsening.

The study had a number of strengths, such as its long follow-up. However, its results were only significant using a subjective, self-reported measure of mental ability. A more objective assessment showed no link. There are many potential explanations for this, including the possibility that higher education compensates in some way.

Still, knowing what we do about blood flow and brain function, a link between memory problems and stroke is plausible.

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Where did the story come from?

The study was carried out by researchers based in the Netherlands and was funded by a range of medical, science and academic research funding bodies from the Netherlands and the European Commission. There were no conflicts of interest reported.

The study was published in Stroke, a peer-reviewedJournal of the American Heart Association. The study has been published on an open-access basisso it is free to read online or download as a PDF.

BBC News reported the study accurately and although it outlined potential implications of the results, it did not discuss any of its limitations.

What kind of research was this?

This was a cohort study (Rotterdam Study) investigating whether memory complaints earlier in life were linked to occurrence of a stroke in later life.

The researchers say that people with cognitive impairment – some impairment of their brain’s ability to function – are at a higher risk of having a stroke.

A stroke is a serious and potentially fatal condition in which the flow of blood to the brain is disrupted. Strokes have two main causes

  • a blood clot blocks the supply of blood to the brain (ischaemic stroke)
  • bleeding occurs inside the brain, usually due to a weakened blood vessel bursting (haemorrhagic stroke)

Both types of stroke can occur in people with cardiovascular disease:

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The research team wanted to know whether there were early signs of cognitive impairment, such as memory lapses, that could help them identify people at higher risk of stroke. If they knew who the high risk people were, they could focus efforts on minimising their risk, potentially preventing some occurrences of stroke.

What did the research involve?

The researchers documented memory complaints and any occurrences of stroke in a group of 9,152 adults over 55 living in Rotterdam, the Netherlands, for an average of 12.2 years.

Trained investigators interviewed all participants at home. The presence of subjective memory complaints was assessed by the question, “Do you have memory complaints?” Cognitive function was assessed using the standard objective measure of the Mini-Mental State Examination. This assesses orientation, memory, attention, language, and visuospatial construction (the ability to recognise a pattern or set of objects and then replicate the pattern or set). It wasn’t clear when the assessment of memory complaints occurred, or whether it was reported over time.

Once enrolled in the study, participants were left to their own devices while the researchers were notified of any reports of stroke in the following years.

People who already had a stroke or had dementia at enrolment into the study were excluded. The number of participants available for analysis was 9,152.

The research team analysed links between memory complaints and incidence of stroke. They also looked at whether education level influenced this link. The analysis took account of a range of known confounders for stroke risk, including:

  • age
  • gender
  • smoking
  • body mass index
  • blood cholesterol levels
  • diabetes
  • blood pressure and blood pressure medications
  • ability to perform activities of daily living – a type of older age disability test

What were the basic results?

Over the study period 1,134 strokes occurred, average follow up was 12.2 years.

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One of the main findings was that people reporting subjective memory complaints were 20% more likely to have a stroke than those who didn’t (Hazard ratio [HR] 1.20, 95% Confidence interval[CI] 1.04 to 1.39). However, this result was not found using the more objective measure of mental ability, the Mini-Mental State Examination. Better point scores on the test were not significantly linked to stroke occurrence (HR 0.99, 95% CI 0.95 to 1.02). These figures come from the analyses that took account of the largest list of confounders.

The second important finding was that level of education was significantly influencing the results. Subjective memory complaints were linked with stroke only in those with high education – defined in this study as higher vocational education or university training (HR 1.39, 95% CI 1.07 to 1.81).

Participants with missing information tended to be older, had more memory complaints, more likely to be female and had slightly worse scores on the assessments of mental abilities. These people were still included in the analysis.

How did the researchers interpret the results?

The researchers concluded “Subjective memory complaints might be an early indicator of stroke risk, especially in highly educated individuals”.


This study showed that highly educated people who notice memory complaints in themselves may be more likely to develop stroke than those who don’t, over an average of 12 years.

The study had a number of strengths, such as its population-based prospective design and availability of data on more than 9,000 participants at baseline with a long follow-up. However, there were also a number of limitations that weaken the strength of the conclusions.

It was not clear whether the memory complaints were assessed just once at the start of the study or an ongoing basis. Some people may report memory complaints that are only temporary, while others not initially reporting complaints may have done so in later years. This could have altered the results, but is only likely to have had a minor influence.

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The results were only significant using the subject measure of mental ability. It would be interesting to explore whether other subjective and objective assessments show a link or not. Results tend to be more reliable if there is consistency between different measures of the same thing, objective or subjective. This was not the case in this study.

The Mini-Mental State Examination is known to be less sensitive in well-educated patients. Possibly a different type of test is required.

Although the study adjusted for a range of confounders, it is difficult to exclude the possibility that residual confounding by measurement error or unmeasured factors biased the results to an unknown degree.

Data on depression and depressive symptoms was not available. The researchers highlight that this was a major limitation, “because it has been suggested that the associations with subjective indicators of health, especially memory, may be confounded by prevalence of depression”.

The bottom line is that this study suggests a link between memory complaints in the highly educated and stroke but does not prove one causes the other. The study authors point to a plausible biological explanation but this was not tested in this study.

The results may warrant further investigation and confirmation in different studies, using different ways of assessing memory. If the link is real, we’d expect to see somewhat consistent results across different measures. Based on this study we can’t say that educated people with memory complaints are definitely at a higher risk of stroke.

Nevertheless, vascular dementia(where reduced blood flow to the brain causes cognitive dysfunction) and stroke are both linked to the same underlying cardiovascular disease process, so a link between memory problems and stroke is plausible – particularly for this specific type of dementia.

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Methods you can use to reduce your stroke risk include eating a healthy diet, taking regular exercise, quitting smoking if you smoke, moderating your consumption of alcohol. Read more about stroke prevention.


Is problems with memory a sign of stroke? ›

Memory loss may be a direct result of stroke but can also be caused or worsened by medications; use of alcohol, tobacco and drugs; lack of sleep; depression and stress; or poor nutrition.

What are the 5 warning signs of a stroke acronym? ›

B.E. F.A.S.T. to spot a stroke
  • B – Balance. The person may suddenly have trouble with balance or coordination.
  • E – Eyes. They could experience sudden blurred, double or total loss of vision. ...
  • F – Face. Do you notice one side of their face drooping? ...
  • A – Arms. ...
  • S – Speech. ...
  • T – Time to get help.
11 May 2021

What type of memory does stroke affect? ›

Two types of memory that can be affected by stroke include the following: Verbal memory – memory of names, stories and information having to do with words. Visual memory – memory of faces, shapes, routes and things seen.

What are the 4 things you should ask someone showing signs of a stroke? ›

If you think someone may be having a stroke, act F.A.S.T. and do the following test:
  • F—Face: Ask the person to smile. ...
  • A—Arms: Ask the person to raise both arms. ...
  • S—Speech: Ask the person to repeat a simple phrase. ...
  • T—Time: If you see any of these signs, call 9-1-1 right away.
  • Note the time when any symptoms first appear.
4 May 2022

What are memory issues a sign of? ›

Many people worry about becoming forgetful. They think forgetfulness is the first sign of Alzheimer's disease. But not all people with memory problems have Alzheimer's. Other causes for memory problems can include aging, medical conditions, emotional problems, mild cognitive impairment, or another type of dementia.

What is memory problems a symptom of? ›

Memory and other thinking problems have many possible causes, including depression, an infection, or medication side effects. Sometimes, the problem can be treated, and cognition improves. Other times, the problem is a brain disorder, such as Alzheimer's disease, which cannot be reversed.

What are 3 warning signs of a stroke? ›

The warning signs of stroke include:
  • Weakness or numbness of the face, arm or leg, usually on one side of the body.
  • Trouble speaking or understanding.
  • Problems with vision, such as dimness or loss of vision in one or both eyes.
  • Dizziness or problems with balance or coordination.
  • Problems with movement or walking.

What is the stroke Mnemonic? ›

The acronym FAST (Facial drooping, Arm weakness, Speech difficulties and Time) has been used by the National Stroke Association, American Heart Association and others to educate the public on detecting symptoms of a stroke.

How do you tell if someone has had a stroke in the past? ›

Wondering how to tell if you had a stroke in the past or how to tell if you had a stroke in your sleep? Unfortunately, most people don't actually find out they've suffered from a silent stroke until they see a doctor for another condition and are ordered to have an MRI or a CT scan.

What part of the brain is damaged with memory? ›

The damaged areas of the brain include the hippocampus, which is an area of the brain that helps new memories form. Damage to the frontal lobe of the brain eventually causes problems with intelligence, judgment, and behaviour. Damage to the temporal lobe affects memory. And damage to the parietal lobe affects language.

Can memory be restored after a stroke? ›

Are there treatments that can help? Cognitive problems are usually worst during the first few months after a stroke, but they can and do get better. They're likely to improve most quickly over the first three months, as this is when your brain is at its most active, trying to repair itself.

What are 3 things that can impact memory? ›

Here are several common factors that can affect your memory:
  • Lack of sleep.
  • Stress and anxiety.
  • Depression.
  • Thyroid problems.
  • Vitamin B12 deficiency.
  • Alcohol abuse.
  • Medication.

What are the 3 questions to ask a stroke victim? ›

A – ARMS: Ask the person to raise both arms. Does one arm drift downward? S – SPEECH: Ask the person to repeat a simple phrase, such as “It may rain today.” Is their speech slurred or strange? T – TIME: If you observe any of these signs, call 9-1-1 immediately.

Can drinking water help prevent a stroke? ›

Drink a lot of water: You should drink at least five glasses of water per day, and this will reduce your risk of stroke by 53%, according to a recent study by Loma Linda University.

Why do you ask a stroke victim to smile? ›

If you notice that someone is having a stroke, ask them to smile, and look to see if one side of their face is drooping or if one side is numb and their smile is uneven.

What is the 5 word memory test? ›

Introduction: The five-word test (5WT) is a serial verbal memory test with semantic cuing. It is proposed to rapidly evaluate memory of aging people and has previously shown its sensitivity and its specificity in identifying patients with AD.

What are the first signs of short term memory loss? ›

What are the symptoms of short-term memory loss?
  • asking the same questions repeatedly.
  • forgetting where you just put something.
  • forgetting recent events.
  • forgetting something you saw or read recently.
30 Nov 2018

What is one of the first signs of cognitive decline? ›

Signs that you may be experiencing cognitive decline include: Forgetting appointments and dates. Forgetting recent conversations and events. Feeling increasingly overwhelmed by making decisions and plans.

What is the best test for memory loss? ›

Health care providers often use a brief test such as the Short Test of Mental Status, the Montreal Cognitive Assessment (MoCA) or the Mini-Mental State Examination (MMSE). More detailed testing may help determine the degree memory is impaired.

How do doctors test for memory problems? ›

In addition to a general physical exam, your doctor will likely conduct question-and-answer tests to judge your memory and other thinking skills. He or she may also order blood tests, brain-imaging scans and other tests that can help identify reversible causes of memory problems and dementia-like symptoms.

What blood tests are done for memory loss? ›

Some of the most common blood tests ordered as part of a diagnostic evaluation for someone with changes in thinking or memory include: CBC (complete blood count), CMP (comprehensive metabolic panel), TSH (thyroid stimulating hormone), vitamin B12, RPR (rapid plasma reagin), HIV (human immunodeficiency virus).

How long do warning signs last before stroke? ›

Warning signs of an ischemic stroke may be evident as early as seven days before an attack and require urgent treatment to prevent serious damage to the brain, according to a study of stroke patients published in the March 8, 2005 issue of Neurology, the scientific journal of the American Academy of Neurology.

What are the ten warning signs for a stroke? ›

10 Signs of Stroke
  • Numbness. An individual may feel sudden numbness in the face or lose feeling in the hands, feet, arms, legs or other extremities. ...
  • Confusion. ...
  • Difficulty Understanding. ...
  • Severe Headache. ...
  • Loss of Balance. ...
  • Loss of Coordination. ...
  • Dizziness. ...
  • Vision Changes.
5 Feb 2021

What are mnemonics give 5 examples? ›

Examples of mnemonics include:
  • Setting the ABCs to music to memorize the alphabet.
  • Using rhymes to remember rules of spelling like "i before e except after c"
  • Forming sentences out of the first letter of words in order (acrostics), such as "Please Excuse My Dear Aunt Sally," to remember the order of operations in algebra.
17 Sept 2022

What is the smile test for stroke? ›

If you think someone is suffering a stroke, give them this test: F = Face — Ask the person to smile. Does one side of the face droop? Is the smile uneven?

Can a doctor tell if you had a mini stroke in the past? ›

The only way to tell the difference between a ministroke and a stroke is by having a doctor look at an image of your brain with either a CT scan or an MRI scan. If you've had an ischemic stroke, it's likely that it won't show up on a CT scan of your brain for 24 to 48 hours. An MRI scan usually shows a stroke sooner.

Can a doctor tell if you have had a stroke in the past? ›

Usually, a silent stroke is discovered unexpectedly on a brain CT or brain MRI. These imaging tests can easily distinguish past strokes from recent strokes.

Can a doctor tell if you had a silent stroke? ›

Symptoms to Watch For

You likely won't know for certain that you have suffered a silent stroke without receiving a brain scan like an MRI or CT scan. After a silent stroke, a brain scan can show small white spots that indicate the presence of lesions.

Does vascular dementia show up on MRI? ›

Vascular dementia is caused by different conditions that interrupt the flow of blood and oxygen supply to the brain and damage blood vessels in the brain. People with vascular dementia almost always have abnormalities in the brain that can be seen on MRI scans.

Why can't I remember things from my past? ›

Memories do fade. The more time that's passed since an experience, the less likely you are to recall all the details. It's fairly easy to remember what you did a few hours ago. But recalling the same events a month or years later is considerably more difficult.

What part of the brain controls balance and walking? ›

The Cerebellum

This area of the brain is responsible for fine motor movement, balance, and the brain's ability to determine limb position.

Can stress cause a stroke? ›

Stress can cause the heart to work harder, increase blood pressure, and increase sugar and fat levels in the blood. These things, in turn, can increase the risk of clots forming and travelling to the heart or brain, causing a heart attack or stroke.

What is the average lifespan after a stroke? ›

A 2021 study found that about 66% of stroke victims survived past the three-year mark. 7 Survival factors included: The person's age.

What is the best exercise for stroke patient? ›

Walking outside or on a treadmill, stationary cycling, recumbent cross training and many other forms of exercise that get your heart pumping are extremely beneficial for stroke recovery.

What improves memory? ›

Proven ways to protect memory include following a healthy diet, exercising regularly, not smoking, and keeping blood pressure, cholesterol, and blood sugar in check. Living a mentally active life is important, too. Just as muscles grow stronger with use, mental exercise helps keep mental skills and memory in tone.

Does anxiety cause memory loss? ›

One part of the body affected by anxiety and stress is the nervous system, which plays a primary role in basic functions like memory and learning. As a result, persistent anxiety and memory loss are associated.

Can you have a mild stroke and not know it? ›

Some people have strokes without realizing it. They're called silent strokes, and they either have no easy-to-recognize symptoms, or you don't remember them. But they do cause permanent damage in your brain. If you've had more than one silent stroke, you may have thinking and memory problems.

What should you not let a stroke victim do? ›

Do not let that person go to sleep or talk you out of calling 911. Stroke survivors often complain of suddenly feeling very sleepy when a stroke first happens. “A lot of patients come in and say they went to sleep for a few hours before they came to the hospital because they were tired,” Dr. Humbert notes.

What time of day do most strokes occur? ›

These data suggest that for each subtype of stroke studied, there is an increase in risk during the early morning hours. There were 21 studies (including 8250 patients) of ischemic stroke, which was 55% (95% CI, 48% to 62%) more likely between 6 am and noon.

What should you not drink before bed? ›

Five drinks to avoid before going to bed
  • Alcohol. It's no secret that alcohol makes you feel drowsy after a few drinks. ...
  • Coffee. The caffeine in coffee can help wake you up in the morning. ...
  • Energy Drinks. For obvious reasons, there is no use in having an energy drink before bed. ...
  • Soda. ...
  • Water.
12 Jul 2022

What does a stroke feel like for a woman? ›

What are the signs of stroke in men and women? Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body. Sudden confusion, trouble speaking, or difficulty understanding speech. Sudden trouble seeing in one or both eyes.

What are the 4 silent signs of a stroke? ›

Silent Stroke Symptoms
  • Sudden lack of balance.
  • Temporary loss of basic muscle movement (bladder included)
  • Slight memory loss.
  • Sudden changes in mood or personality.
  • Issues with cognitive skills and ability.

What are the 5 warning signs of a mini stroke? ›

Warning Signs of Stroke
  • Weakness or numbness of the face, arm or leg, usually on one side of the body.
  • Trouble speaking or understanding.
  • Problems with vision, such as dimness or loss of vision in one or both eyes.
  • Dizziness or problems with balance or coordination.
  • Problems with movement or walking.
  • Fainting or seizure.

What are the signs of a silent stroke? ›

Silent Stroke Symptoms
  • Sudden lack of balance.
  • Temporary loss of basic muscle movement (bladder included)
  • Slight memory loss.
  • Sudden changes in mood or personality.
  • Issues with cognitive skills and ability.

Can a stroke seem like dementia? ›

Stroke (infarction) blocking a brain artery.

Strokes that block a brain artery usually cause a range of symptoms that may include vascular dementia. But some strokes don't cause any noticeable symptoms. These silent strokes still increase dementia risk.

Can you have memory loss before a stroke? ›

A transient ischemic attack (TIA) is a brief episode during which parts of the brain do not receive enough blood. Because the blood supply is restored quickly, brain tissue is not permanently damaged. These attacks are often early warning signs of a stroke, however. In rare cases, TIA can cause memory loss.

Why do I forget things immediately after thinking of them? ›

Forgetfulness can arise from stress, depression, lack of sleep or thyroid problems. Other causes include side effects from certain medicines, an unhealthy diet or not having enough fluids in your body (dehydration). Taking care of these underlying causes may help resolve your memory problems.

Can doctors tell if you've had a mini stroke? ›

The only way to tell the difference between a ministroke and a stroke is by having a doctor look at an image of your brain with either a CT scan or an MRI scan. If you've had an ischemic stroke, it's likely that it won't show up on a CT scan of your brain for 24 to 48 hours. An MRI scan usually shows a stroke sooner.

Can doctors tell if you had a stroke in the past? ›

Usually, a silent stroke is discovered unexpectedly on a brain CT or brain MRI. These imaging tests can easily distinguish past strokes from recent strokes.

What are the first signs of vascular dementia? ›

Early signs of vascular dementia can include mild:
  • slowness of thought.
  • difficulty with planning.
  • trouble with understanding.
  • problems with concentration.
  • changes to your mood or behaviour.
  • problems with memory and language (but these are not as common as they are in people with Alzheimer's disease)

What are the seven signs of vascular dementia? ›

Common symptoms of vascular dementia
  • Confusion.
  • Difficulty concentrating and communicating.
  • Slowed thinking abilities.
  • Memory issues.
  • Depression or irritability.
  • Urinary issues.
  • Issues with balance and movement.
28 Feb 2022

Can a mild stroke cause memory loss? ›

Problems with memory and thinking (cognitive problems) are very common after a stroke. They are most common soon after a stroke and like many effects of stroke, the fastest recovery takes place in the days and weeks after a stroke.

How do you test for memory loss? ›

The MMSE is a quick test designed to measure cognitive function in the early stages of dementia and Alzheimer's disease. There is a free version available that may be helpful for assessing your memory as well as attention, language, and motor skills.

Can a silent stroke cause memory loss? ›

If an individual has recurrent silent strokes, it can cause significant and permanent damage. They can lead to cognitive decline and dementia, with a severe impact on memory. Over time, the effects of multiple silent strokes can accumulate, leading to more memory damage and other issues.

What is a silent mini stroke? ›

A silent stroke refers to a stroke that doesn't cause any noticeable symptoms. Most strokes are caused by a clot that blocks a blood vessel in the brain. The blockage prevents blood and oxygen from reaching that area, causing nearby brain cells to die.

Why do I forget what I'm saying mid sentence? ›

When one's brain is inflamed, certain brain functions are impacted, likely contributing to brain fog. Other components, like lack of sleep, stress, anxiety, or dietary changes, can also lead to lethologica,” Hafeez explains.

At what age does memory decline? ›

Almost 40% of us will experience some form of memory loss after we turn 65 years old. But even if we experience memory loss, chances are still unlikely that we have dementia. For the most part, our memory loss is mild enough that we can still live our day-to-day lives without interruption.

Why am I not able to remember what I study? ›

Major memory changes don't always signal Alzheimer's disease. They can be caused by strokes, head injuries, lack of vitamins in your diet, or sleep trouble. They might even be a side effect of one of the drugs you're taking. When in doubt, see a doctor to sort it out.


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