News Release

Moving later in life may not lower cognitive decline linked to Stroke Belt

American Stroke Association International Stroke Conference -- poster presentation WP482

Peer-Reviewed Publication

American Heart Association

DALLAS, Feb. 12, 2020 -- People who spent their childhood or early adulthood in the Stroke Belt are more likely to develop cognitive impairment later in life, even if they have moved away, according to preliminary research to be presented at the American Stroke Association's International Stroke Conference 2020 - Feb. 19-21 in Los Angeles, a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

Conversely, those who reside in the Stroke Belt - eight states in the southeastern United States with elevated stroke rates (Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, South Carolina and Tennessee) - when they are middle-aged and older yet lived somewhere else as a child or young adult are provided some protection.

"Risk factors for both stroke and cognitive decline, such as smoking and high blood pressure, may be more common in the Stroke Belt than elsewhere in the country - even in children and young adults," said Virginia J. Howard, Ph.D., lead author of the study and a professor of epidemiology at the University of Alabama at Birmingham School of Public Health.

Researchers compared almost 11,500 people (average age 64) residing in the Stroke Belt with nearly 9,000 (average age 65) people living outside of it. All are participants in the large, ongoing REGARDS (Reasons for Geographic and Racial Differences in Stroke) study.

None of the participants in the current study previously suffered a stroke before enrolling in REGARDS at age 45 or older. Based on a screening test of memory and thought-processing speed all were considered cognitively intact at the beginning of the study. The screening test was repeated annually, with an average of nine years between the first and last testing. Cognitive screening results were adjusted for age, sex, race and time between testing.

Among older adults currently living in the Stroke Belt, compared to lifelong residents, researchers found:

  • Those who spent all their childhood (ages 0-18) outside the Stroke Belt were 24% less likely to develop cognitive impairment;
  • Those who spent some of their childhood elsewhere were 18% less likely to show impairment;
  • Those who spent all their early adulthood (ages 19-30) outside the Stroke Belt were 30% less likely to develop cognitive impairment; and
  • Those who spent part of the early adulthood elsewhere were 14% less likely to show impairment.

When researchers compared older persons currently living outside the Stroke Belt to those who had never lived there, they found:

  • Those who spent their entire young adulthood within the Stroke Belt were 51% more likely to develop cognitive impairment;
  • There was no difference in risk of cognitive impairment in those who spent all or part of their childhood, or some but not all their young adulthood within the Stroke Belt.

"These findings suggest that early residence in the Stroke Belt during childhood or early adulthood may increase the risk of cognitive impairment, no matter where you live in later adulthood. Many of the risk factors for brain health are similar to the risk factors for stroke health and heart disease. Our research suggests prevention strategies should be started as early in life as possible," Howard said. "We also need further research to determine the characteristics of early Stroke Belt life that are linked to later adult cognitive impairment."

This analysis was limited, as it used a single screening test for cognitive impairment. "We are currently analyzing additional measures of cognitive abilities that were also used in the study," said Howard.


Co-authors are George Howard, Dr.P.H.; Jennifer J. Manly, Ph.D.; M. Maria Glymour, Sc.D.; Laura B. Zahodne, Ph.D.; Michael G. Crowe, Ph.D.; Aleena Bennett, M.S.; Leslie A. McClure, Ph.D.; Frederick W. Unverzagt, Ph.D.; and Virginia G. Wadley, Ph.D. Author disclosures are available in the abstract.

The study was funded by the National Institute of Neurological Disorders and Stroke and the National Institute on Aging at the National Institutes of Health.

Additional Resources:

Video interview: AHA/ASA Vice Chair of the International Stroke Conference and volunteer expert, Louise McCullough, M.D., offers perspective (via Zoom) and images may be downloaded from the right column of the release link (click through thumbnails to select).

AHA/ASA Presidential Advisory: Seven steps to keep your brain healthy from childhood to old age

ASA: Additional Factors That May Be Linked to Higher Stroke Risks

For more news at ASA International Stroke Conference 2020, follow us on Twitter @HeartNews #ISC20.

Statements and conclusions of study authors that are presented at American Stroke Association scientific meetings are solely those of the study authors and do not necessarily reflect Association policy or position. The Association makes no representation or warranty as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at

The American Stroke Association's International Stroke Conference (ISC) is the world's premier meeting dedicated to the science of stroke and brain health. ISC 2020 will be held February 19-21 at the Los Angeles Convention Center in California. The 2 ½-day conference features more than 1,600 compelling scientific presentations in 21 categories that emphasize basic, clinical and translational science for health care professionals and researchers. These science and other clinical presentations will provide attendees with a better understanding of stroke and brain health to help improve prevention, treatment and outcomes for the more than 800,000 Americans who have a stroke each year. Stroke is the fifth leading cause of death and a leading cause of serious, long-term disability in the U.S. Worldwide, cerebrovascular accidents (stroke) are the second leading cause of death and the third leading cause of disability, according to the World Health Organization. Engage in the International Stroke Conference on social media via #ISC20.

About the American Stroke Association

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