Severe Mental Illness Linked to Dementia and Stroke Risk

Key Takeaways

• In the large Catalonia PADRIS-PRESTO health-records cohort, severe mental illness was associated with dementia across adulthood.
• The largest relative dementia gap appeared in younger adults, even though absolute prevalence in that age range remained low.
• Dementia associations persisted into older age rather than narrowing to only midlife findings.
• Ischemic stroke associations were most pronounced in early and middle adulthood.

In the European Neuropsychopharmacology PADRIS-PRESTO study, De Prisco and colleagues used a cross-sectional health-records design in Catalonia, Spain to compare dementia and ischemic stroke across ages 20 to 99 years. The analysis included nearly 700,000 participants, with about 177,000 in a combined severe mental illness (SMI) group defined by schizophrenia, bipolar disorder, or major depression and around 517,000 without a psychiatric diagnosis.

Across the adult age range, SMI was significantly associated with dementia at every age studied. In adults aged 30 to 39, SMI was linked to more than 20-fold higher odds of dementia, with about 0.55% versus 0.02% prevalence and about 550 versus 24 cases per 100,000. Even with that pronounced relative gap, dementia remained uncommon in that decade of life.

The dementia association extended into later life, with adults aged 80 to 89 showing roughly fourfold higher odds than peers without a psychiatric diagnosis. Ischemic stroke followed a different age pattern, reaching nearly threefold higher odds at ages 40 to 49 and remaining especially marked across early and middle adulthood.

Because the analysis provided a cross-sectional snapshot rather than patient follow-up, the findings show association rather than cause and effect. The investigators interpreted the pattern as suggesting that neurologic and vascular risks linked to SMI may emerge earlier than commonly expected, within a whole-person view of mental, neurologic, and cardiovascular health.

Overall, the Catalonia analysis linked SMI with dementia throughout adulthood and with earlier-life vulnerability to ischemic stroke.

Clinician Questions

How uncommon was dementia in adults aged 30 to 39 despite the large relative gap linked to severe mental illness?

Dementia remained rare overall in adults aged 30 to 39 despite the large relative association with severe mental illness.

What follow-up research did investigators propose after the PADRIS-PRESTO analysis?

The investigators said the next step is longitudinal follow-up of individual patients, which would move beyond the current cross-sectional snapshot; they also described testing systems that integrate mental and physical care.