Nikhil Prasad Fact checked by:Thailand Medical News Team Sep 18, 2026 49 minutes ago
Thirty-five years of CARDIA data indicated that elevated systolic blood pressure and smoking before age 40 predicted later cognitive decline. Declining participants also exhibited faster white-matter damage and changes across several brain regions and networks. The findings suggest that vascular health during young adulthood may influence how the brain ages decades later.
Higher blood pressure and smoking before age 40 were associated with poorer midlife cognition and faster structural brain changes.
Tracking Brain Health Across Decades
Researchers analyzed data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, which began in 1985–1986 with 5,115 Black and White adults aged 18 to 30. The analysis combined decades of vascular measurements with cognitive testing and brain magnetic resonance imaging (MRI).
The researchers are from Northwestern University Feinberg School of Medicine; University of Massachusetts Dartmouth; Boston University Chobanian & Avedisian School of Medicine; University of Minnesota School of Public Health; National Institute on Aging; University of California, San Francisco; and University of Pennsylvania.
For longitudinal analyses, 280 participants with cognitive and imaging data from at least two visits were classified into two groups: 134 whose cognition declined and 146 whose performance remained stable. Cognitive testing examined verbal memory, processing speed, and executive function.
Blood Pressure Before 40 Stood Out
In this
Thailand Medical News report, systolic blood pressure (SBP) before age 40 emerged as the strongest vascular predictor of cognitive-group membership, with an importance score of 0.30. Smoking before 40 ranked next at 0.20, while SBP and smoking after 40 contributed less strongly. The predictive model achieved an area under the curve of 0.792 and 75.3% accuracy.
The researchers further tested the relationship in 720 participants, dividing pre-40 SBP into approximately 100, 110, and 120 mmHg groups. Cognitive performance in late midlife worsened progressively across these categories, with participants in the highest group performing significantly worse than those with moderate or lower pressures. Within each blood-pressure category, people who had smoked more than 5.6 cigarettes daily before 40 also recorded lower average cognitive scores than nonsmokers.
Brain Scans Revealed Faster Damage
MRI provided evidence that cognitive differences accompanied measurable brain changes. By late midlife, participants in the declining group had accumulated 2,195 mm³ of white matter hyperintensities, compared with 1,672 mm³ in the stable group—approximately twice the accumulation rate over 10 years. Greater volume loss also appeared in frontal and temporal regions, the occipital pole, and thalamus.
Network analysis additionally identified altered connections centered on the basal forebrain, a region involved in cognitive function. The authors cautioned that participants did not have clinical dementia and that the observat
ional study cannot establish that higher blood pressure directly caused the brain changes.
Conclusions
The findings indicate that vascular exposures beginning well before middle age may accompany later cognitive and structural brain changes. Earlier control of elevated blood pressure and avoidance of smoking could therefore represent important targets for future studies investigating strategies to preserve long-term brain health.
The study findings were published in the peer reviewed journal: Stroke.
https://www.ahajournals.org/doi/10.1161/STROKEAHA.126.055765
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