“[Abstract] At least 60% of stroke, 40% of dementia and 35% of late-life depression (LLD) are attributable to modifiable risk factors, with great overlap due to shared pathophysiology. [..] Identified risk factors included alcohol (normalised β-coefficient highest category: −34), blood pressure (130), body mass index (70), fasting plasma glucose (94), total cholesterol (22), leisure time cognitive activity (−91), depressive symptoms (57), diet (51), hearing loss (60), kidney function (101), pain (42), physical activity (−56), purpose in life (−50), sleep (76), smoking (91), social engagement (53) and stress (55).
[article’s Discussion section] When assessing individual components, hypertension emerged as the factor with the highest individual impact. This is mainly attributable to the well-established significant association between stroke and hypertension, and is reinforced by our methods’ DALY [disability-adjusted life-year]-based weighting system, which assigns greater impact to stroke compared with dementia or LLD. Regarding cholesterol, the impact was limited, with no significant effect observed for LDL levels. We focused on all strokes, not distinguishing between ischaemic and haemorrhagic types, which might have attenuated the effect due to the contradicting impact of cholesterol levels across stroke subtypes. Additionally, excluding meta-analysis on specific treatments or dose-responses limited the number of eligible cholesterol studies. We also reported substantial impact of leisure time cognitive activities, purpose in life and absence of social isolation. These impacts are mainly due to their association with dementia, where reverse causality may play a significant role. Further, long sleep duration emerged as a major risk factor, potentially due to its relationship with possible confounders such as obesity, hypertension and diabetes or due to reverse causality or confounding by ageing. We focused on individual dietary elements as outlined by AHA Life’s Essential 8 and the DASH diet. While we did not explore the complex interplay between these dietary components, there could be an overestimation of the weights of diet if combined in a future tool that builds on the results of our analysis. Furthermore, dietary comparisons were often made between the highest and lowest quartiles, limiting the clinical applicability. Pain showed a significant effect on dementia risk, likely due to the direct effects of pain and the associated reduction in physical activity, as well as possible reverse causality. Finally, depression was included in our analysis not only as an outcome but also as a risk factor due to its bidirectional association with cerebrovascular disease. Depressive symptoms were associated with an increased risk of stroke, which might be due to both immunological and inflammation effects, as well as their association with poor health behaviours such as smoking and physical inactivity. Since we did not include disease-specific populations, we did not examine the associations of poststroke depression or poststroke dementia.”
Full article, J Senff, RWP Tack, A Mallick et al., BMJ Journals: Journal of Neurology, Neurosurgery & Psychiatry, 2025.4.3