A large analysis of health records from Catalonia, Spain, has found that people living with severe mental illness face substantially higher recorded rates of dementia throughout adulthood and markedly elevated odds of ischemic stroke during early and middle adulthood. The study, involving nearly 700,000 people, suggests that neurological and cardiovascular vulnerabilities associated with schizophrenia, bipolar disorder and major depression may become visible decades earlier than conventional clinical expectations about “old-age” diseases. The findings strengthen calls for mental-health services to incorporate routine monitoring of cognitive, vascular and general physical health rather than treating psychiatric and medical care as separate systems.
Researchers examined data from approximately 177,000 people diagnosed with at least one severe mental illness and around 517,000 people without a recorded psychiatric diagnosis. The records came from the PADRIS-PRESTO cohort, a large health-information resource covering the Catalan population. The investigators compared the prevalence of dementia and ischemic stroke across age groups ranging from 20 to 99 years. Because the analysis was age-stratified, it allowed the team to examine whether the association between psychiatric illness and brain-related disease was confined to older adults or was already apparent among younger people.
The association with dementia was statistically significant in every age group studied. The most striking relative difference appeared among adults aged 30 to 39, a period when clinically diagnosed dementia remains uncommon in the general population. Among people without severe mental illness, approximately 24 individuals per 100,000 had dementia, compared with about 550 per 100,000 among those with severe mental illness. Although the absolute numbers were small, the contrast corresponded to roughly 20-fold higher odds of recorded dementia in the group with severe mental illness. In percentage terms, the reported prevalence was approximately 0.55 percent among people with severe mental illness and 0.02 percent among controls.
“These findings are notable because dementia remains rare in that 30-to-39 age group overall,” said co-lead author Michele De Prisco of Hospital Clínic-IDIBAPS and the University of Barcelona. “The size of the difference associated with severe mental illness was nevertheless substantial.” The researchers stress that a relative increase of this magnitude does not mean that dementia is common among young adults with psychiatric diagnoses. Instead, it illustrates how a very low baseline prevalence can produce a large relative contrast when the affected group has a higher burden of cognitive or neurological problems. In older adults aged 80 to 89, the relative association was smaller but remained pronounced: people with severe mental illness had approximately four times the odds of dementia compared with those without a psychiatric diagnosis.
The pattern for ischemic stroke was particularly evident in younger and middle-aged adults. Ischemic stroke occurs when a blood vessel supplying the brain becomes blocked, depriving brain tissue of oxygen and potentially causing permanent neurological injury. Adults aged 40 to 49 with severe mental illness had nearly three times the odds of ischemic stroke compared with controls. The results indicate that excess cerebrovascular risk may be especially important during a stage of life when stroke is often considered unusual and when preventive screening may be less intensive than it is among older adults. The study did not establish the precise mechanisms behind the association, but several pathways may contribute, including smoking, diabetes, obesity, hypertension, dyslipidemia, sleep disruption, social disadvantage, chronic stress and reduced access to preventive medical care.
Medication exposure and illness-related biology may also be relevant, although the observational design cannot determine the contribution of any individual factor. Some antipsychotic and mood-stabilizing treatments can influence body weight, glucose regulation or lipid levels, while depression, bipolar disorder and schizophrenia themselves have been associated with inflammatory, metabolic and vascular changes. Severe psychiatric symptoms may also make it harder for patients to attend appointments, describe physical symptoms or receive timely treatment for cardiovascular risk factors. Conversely, early cognitive or vascular disease can sometimes produce psychiatric symptoms, impair functioning or complicate diagnosis. The researchers therefore caution against interpreting the associations as evidence that mental illness directly causes dementia or stroke.
The study’s cross-sectional design provides a snapshot of diagnoses recorded in health systems rather than a timeline of disease development. Researchers could identify co-occurring conditions and compare their frequency by age, but they could not determine whether severe mental illness preceded dementia or stroke, whether one condition accelerated the other, or whether unmeasured differences between the groups explained part of the result. Health-record studies may also be influenced by diagnostic practices. People receiving regular psychiatric care may have more frequent contact with health professionals, increasing the likelihood that cognitive impairment or vascular disease will be detected and recorded. At the same time, fragmented care could cause other conditions to go undiagnosed, meaning that administrative data may both overestimate and underestimate specific associations.
Michele De Prisco said the findings should encourage clinicians to regard severe mental illness as a whole-person health condition. “Risks linked to subsequent dementia and stroke may appear much earlier in life than many people expect,” he said, arguing that prevention and coordinated monitoring should begin earlier rather than waiting until patients reach older age. In practice, an integrated approach could include regular assessment of blood pressure, blood glucose, cholesterol, smoking, physical activity, sleep and weight alongside psychiatric symptoms. Cognitive screening may also help clinicians distinguish persistent cognitive impairment from temporary difficulties related to mood episodes, psychosis, medication effects or sleep deprivation. Such assessments would not be intended to label younger patients with dementia prematurely, but to identify potentially reversible contributors and track meaningful changes over time.
Kamilla Miskowiak, professor at the University of Copenhagen, who was not involved in the research, said the results reinforce the importance of making cognitive and brain health treatment targets in severe mental illness. Cognitive impairment affects most people with schizophrenia and a substantial proportion of people with bipolar disorder and major depression, sometimes continuing even when psychiatric symptoms are stable. She pointed to cardiovascular risk management and cognitive remediation—structured interventions designed to improve functions such as memory, attention and problem-solving—as examples of measures that may support long-term outcomes. However, she also noted that more effective treatments specifically targeting cognition are urgently needed. The authors of the study say their next step is to conduct longitudinal research that follows individuals over time, examines potential biological and social mechanisms, and tests whether integrated mental and physical health-care systems can reduce the burden of dementia and stroke.
Subject of Research: People
Article Title: Age-stratified associations between severe mental illness, dementia, and ischemic stroke: findings from the PADRIS-PRESTO cohort
Web References: European Neuropsychopharmacology, Volume 110, September 2026, Article 112850; DOI: https://doi.org/10.1016/j.euroneuro.2026.112850
References: De Prisco, Michele; Oliva, Vincenzo; Sanchez-Valle, Raquel; Parellada, Eduard; Junque, Carme; Martí, Maria J.; Bortolozzi, Analia; Alberch, Jordi; Garrabou, Gloria; Sanchez-Vives, Maria V.; Giralt, Albert; Segura, Barbara; Lladó, Albert; Compta, Yaroslau; Radua, Joaquim; Vieta, Eduard; Hidalgo-Mazzei, Diego; Anmella, Gerard. “Age-stratified associations between severe mental illness, dementia, and ischemic stroke: findings from the PADRIS-PRESTO cohort.” European Neuropsychopharmacology, 2026, 110, 112850.
Keywords: severe mental illness, schizophrenia, bipolar disorder, major depression, dementia, ischemic stroke, cognitive impairment, cardiovascular health, brain health, integrated care, observational study, Catalonia, PADRIS-PRESTO cohort
