A LARGE population-based study has found that severe mental illness is strongly associated with higher rates of dementia and ischemic stroke, with associations varying markedly by age across the lifespan.
People with severe mental illness, including schizophrenia spectrum disorders, major depressive disorder, and bipolar disorder, continue to experience elevated physical comorbidity and premature mortality, with dementia and ischemic stroke contributing substantially to this burden. Age-specific patterns underlying these associations have remained poorly characterised, limiting targeted screening in psychiatric care. Researchers have therefore examined how the relationship between severe mental illness, dementia, and ischemic stroke varies across adulthood.
This population-based cross-sectional study used the PADRIS-PRESTO cohort, integrating primary and specialised care records from the Catalan public health system in Spain. Adults with a lifetime severe mental illness diagnosis were compared with controls without any psychiatric condition, among 694,086 participants, of whom 176,870 had severe mental illness.
Weighted age-stratified prevalence was calculated, and logistic regression models estimated age-specific odds ratios with 95% confidence intervals, adjusting for socioeconomic status, comorbidity burden, and, in a further model, BMI and smoking status.
Dementia prevalence was 3.49% in the severe mental illness group versus 0.36% in controls, and ischemic stroke prevalence was 5.3% versus 2.75%. The association between severe mental illness and dementia was significant across all age groups, strongest at 30 to 39 years (OR 23.21, 95% CI 13.74 to 39.19).
Elevated odds of ischemic stroke persisted up to 70 to 79 years, peaking at 40 to 49 years (OR 2.99, 95% CI 2.63 to 3.41), with no significant difference in older groups after full adjustment. Patterns were broadly consistent across schizophrenia spectrum disorders, major depressive disorder, and bipolar disorder, although stroke odds attenuated with age and were lower than controls by 80 to 89 years for schizophrenia spectrum disorders and bipolar disorder.
These findings have highlighted a consistent, age-dependent link between severe mental illness, dementia, and ischemic stroke that spans early adulthood to old age. As this remains a cross-sectional study, the associations cannot establish causation. The authors have called for earlier and more systematic neurological and cardiometabolic screening within psychiatric care, and for policies that recognise severe mental illness as a risk factor for vascular disease and dementia.
Reference
De Prisco M et al. Age-stratified associations between severe mental illness, dementia, and ischemic stroke: findings from the PADRIS-PRESTO cohort. European Neuropsychopharmacology. 2026;110:112850.
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