Kimberly Hreha, Marissa C. Ashner, Sarah Peskoe, Brian Downer, Timothy Reistetter, Priya Palta, Lisa Wruck, Rebecca F. Gottesman, Beverly G. Windham, Heather E. Whitson
Introduction and Background
Strokes are common in the United States, with the approximately 800,000 survivors each year often living with disabling consequences. One frequent complication is stroke-related vision impairment (SRVI), which can include loss of half of the visual field in each eye (homonymous hemianopia), double vision (diplopia), or cranial nerve dysfunction. While general age-related vision impairment is a known risk factor for dementia, researchers are now investigating if vision impairment caused by a stroke increases the risk or speeds up the onset of dementia. Understanding these relationships is vital for improving post-stroke care and identifying patients at the highest risk for cognitive decline.
Data and Methods
The data for these studies come from the Atherosclerosis Risk in Communities (ARIC) study, a long-term project following nearly 16,000 participants from four U.S. communities: Forsyth County, NC; Jackson, MS; Minneapolis, MN; and Washington County, MD.
The first study analyzed a group of 233 stroke survivors to compare the effects of vision impairment present before the stroke (like cataracts or glaucoma) versus impairment caused by the stroke. This study used multivariable logistic regression to calculate the odds of having a dementia diagnosis for stroke survivors with SRVI versus those without.
The second study focused on 787 stroke survivors to determine if SRVI affected the time it took to develop dementia. It used a survival model to predict the probability of someone receiving a dementia diagnosis over time, accounting for the fact that some participants may die or be lost to follow up before receiving a dementia diagnosis.
Both studies adjusted for factors like age, education, and stroke severity.
Results
The findings suggest a complex relationship between vision and brain health:
- Increased Odds of Dementia: Stroke survivors with SRVI initially showed a 2.3-fold increase in the odds of having dementia compared to those without vision issues. However, this association was not significant after adjusting for stroke severity.
- Time to Dementia Diagnosis: The survival analysis found that SRVI did not predict how quickly dementia developed.
- The Role of Stroke Severity: In both studies, when researchers accounted for the severity of the stroke, the associations between vision impairment and dementia or time to dementia diagnosis weakened. This suggests that stroke severity may influence both vision impairment and cognitive decline.
- Specific Vision Impairments: Visual field loss—with a 2.4-fold increase in odds of dementia—appeared to be a stronger indicator of dementia risk than other types of vision issues like double vision, which were not associated with dementia.
Public Health Implications and Future Directions
Although caution should be taken in generalizing results to the rest of the population, because the sample was from four specific communities and only Black and White participants were represented, there are still several key applications and directions for public health programs:
- Clinical Screening: Medical providers should test vision after a stroke—especially loss of part of the visual field—as an important marker of brain changes that may increase the risk of memory and thinking problems.
- Diagnostic Accuracy: There is a need for vision-friendly cognitive tests to be used in older adult and stroke research. Some current assessments require patients to see and match symbols; visually impaired patients may receive an inaccurate cognitive score simply because they cannot see the test clearly.
- Targeted Rehabilitation: Differentiating between pre-existing vision conditions and new stroke-related impairments is crucial for developing personalized rehabilitation plans that may help preserve quality of life and cognition.
- Future Research Needs: Prospective research is needed with a larger and more differing stroke population, to better understand how distinct types of vision impairments are linked to long-term changes in cognition.
Read the Original Papers
Hreha, K., Ashner, M. C., Peskoe, S., Downer, B., Reistetter, T., Palta, P., Wruck, L., Gottesman, R. F., Windham, B. G., & Whitson, H. E. (2026). Prevalence of pre-stroke and stroke-related vision impairments and their association with mild cognitive impairment and dementia. Journal of Alzheimer’s Disease: JAD, 110(1_suppl), S38–S49. https://doi.org/10.1177/13872877251404018
Hreha, K., Ashner, M. C., Peskoe, S., Reistetter, T., Palta, P., Wruck, L., Gottesman, R., Windham, B. G., & Whitson, H. E. (2025). Investigating stroke-related vision impairments and time to incident dementia diagnosis. Journal of Stroke and Cerebrovascular Diseases: The official journal of National Stroke Association, 34(12), 108480. https://doi.org/10.1016/j.jstrokecerebrovasdis.2025.108480
Acknowledgements
This research was supported by the National Institutes of Health (NIH) through multiple components, including the Eunice Kennedy Shriver National Institute of Child Health and Human Development (Grant K01HD106010, PI: Kimberly Hreha) and the National Center for Advancing Translational Sciences (Grant UL1TR002553 supporting the Biostatistics, Epidemiology and Research Design Methods Core). Additional support was provided by the Duke Claude D. Pepper Older Americans Independence Center (NIA P30AG028716), the Duke Aging Center, and Duke University.
The Atherosclerosis Risk in Communities (ARIC) study was supported by Federal funds from the National Heart, Lung, and Blood Institute under Contracts 75N92022D00001 through 75N92022D00005. The ARIC Neurocognitive Study received funding from the NIH (including the National Heart, Lung, and Blood Institute; National Institute of Neurological Disorders and Stroke; National Institute on Aging; and National Institute on Deafness and Other Communication Disorders) under Grants U01HL096812, U01HL096814, U01HL096899, U01HL096902, and U01HL096917. The authors also acknowledge the contributions of the ARIC studystaff and participants.
San Antonio CAPAS acknowledges the use of AI to support the elaboration of the initial draft. See the process by which our team created the synopsis: Research Synopsis Elaboration.