A new risk prediction tool can accurately identify stroke survivors with the highest risk for developing dementia within a decade of having a stroke, according to a large Canadian study. The research, to be presented at the American Stroke Association’s International Stroke Conference 2026, analyzed health records for nearly 50,000 adults hospitalized with stroke to create and validate a model that estimates dementia risk. Researchers found that people with stroke and transient ischemic attack (TIA) are at high risk of subsequent dementia, but prediction tools have been lacking.
Lead study author Raed A. Joundi, M.D., D.Phil., M.Sc., noted that previous research found about 1 in 3 adults developed dementia after stroke over the long-term. The new tool stratifies people into five different levels of dementia risk after stroke based on underlying health, stroke characteristics and risk factors. The analysis identified several factors linked with higher dementia risk after stroke, including being older, having any disability before the stroke, having greater disability after the stroke, having an intracerebral hemorrhage compared to an ischemic stroke, having diabetes, experiencing cognitive symptoms during hospitalization, or suffering from depression.
For those who had a transient ischemic attack, the top risk factors were older age, needing help with activities of daily living prior to TIA, having diabetes, depression, cognitive symptoms on presentation, and any disability at hospital discharge. The risk calculator categorized individuals into different levels of estimated risk over the next ten years after a stroke. Those in the highest category had a 50% probability of dementia over ten years, compared to participants in the lowest risk category who had a 5% probability.
The tool was derived using data from the Ontario Stroke Registry and validated in the separate Ontario Stroke Audit. More information about the study can be found in the abstract in the American Stroke Association International Stroke Conference 2026 Online Program Planner. According to Joundi, the goal is to have a practical, bedside tool that can predict dementia risk after a stroke. The tool predicts dementia rates that are very close to the observed rates and may help to enroll high-risk patients who have had transient ischemic attack, ischemic stroke or intracerebral hemorrhage in clinical trials that are focused on reducing the long-term risk of dementia.
The study authors note that the current focus is on stratifying patients for research studies and clinical trials of dementia prevention, rather than clinical decision-making or treatment. American Stroke Association volunteer expert Deborah A. Levine, M.D., M.P.H., who was not involved in the study, commented on its significance. Dementia after a stroke is very difficult for patients and their loved ones, and there aren't enough effective treatments to help. This well-done study provides a useful tool that could make research faster, so new treatments can get to stroke survivors sooner.
The study is considered preliminary until published as a full manuscript in a peer-reviewed scientific journal, as abstracts presented at the association's scientific meetings are not peer-reviewed. Joundi emphasized the importance of addressing dementia risk in stroke survivors. While traditional focus has been on preventing another stroke, which is very important, more attention needs to be paid to the development of dementia and how to prevent it. Over the long-term, dementia is more common than a recurrent stroke. Healthy lifestyle choices and controlling vascular risk factors can lower the risk of dementia, but new and effective targeted interventions for dementia prevention are needed.
The research comes at a critical time, as stroke remains a significant health concern. According to the American Heart Association’s 2026 Heart Disease and Stroke Statistics, stroke is now the fourth leading cause of death in the U.S. The development of this prediction tool represents an important step toward addressing the substantial dementia risk faced by stroke survivors and could significantly accelerate research into preventive interventions for this vulnerable population.
