People who Grew up in the ‘Stroke Belt’ Have a Greater Risk of Developing Cognitive Decline Later in Life

New research suggests that people who grew up 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) – have a greater risk of developing cognitive impairment later in life. The preliminary research will be presented at the American Stroke Association’s International Stroke Conference 2020 – Feb. 19-21 in Los Angeles.

“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 in a press release.

In the study, researchers compared approximately 11,500 people with a mean age of 64 living in the Stroke Belt with nearly 9,000 with a mean age of 65 people living outside of it. No participant in the study suffered a stroke before enrolling in the study at the age of 45 or older, and at baseline all were considered cognitively healthy.

According to the results of the study, compared to lifelong Stroke Belt residents, those who grew up 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 individuals who spent part of the early adulthood elsewhere were 14% less likely to show impairment.

Moreover, when compared to older people currently residing outside the Stroke Belt to those who had lived there, the former were 51% more likely to develop cognitive impairment. However, the researchers found 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.”