Shruti Sonni, MD

  • Sabayan B
  • Gussekloo J
  • de Ruijter W
  • Westendorp RGJ
  • and de Craen AJM. 
  • Framingham Stroke Risk Score and Cognitive Impairment for Predicting First-Time Stroke in the Oldest Old. Stroke. 2013


    The Framingham stroke risk score is composed of conventional vascular risk factors, and predicts stroke risk in middle aged and the younger old population. Studies have suggested that factors like hypertension, hypercholesterolemia and diabetes tend to lose their predictive value with advancing age. In this study, Sabayan et al. set out to compare the performance of the Framingham stroke risk score and the Mini-Mental State Examination (MMSE) in predicting five-year risk of first time stroke in people aged 85 years and older. They found that the Framingham risk score did not predict stroke risk in this population, but the MMSE showed a graded and sustained relationship between decreasing cognitive function and stroke incidence. 

    The relationship between cognitive impairment and increased risk of stroke has been established in earlier large studies. This was the first study to reproduce these findings in the oldest old population, a population that is on the rise in developed countries, and hence of growing public health importance. The drawback of this study is the lack of neuroimaging, rendering the authors unable to identify type of stroke and silent strokes, which would affect risk of recurrent stroke. Also, the MMSE is not ideal to evaluate cognitive impairment due to vascular causes, unlike the Montral Cognitive Assessment (MoCA). Nevertheless, this study builds the case that cognitive impairment is a tool for predicting stroke risk in not only the younger old, but the oldest old as well.