Glasgow stroke patients 'failed' for eighth year as charity warns of 'devastating' impact

 Measuring 'care', NOT RECOVERY means you don't know what the fuck you need to do! Let survivors run the show, not you blithering idiots!

Glasgow stroke patients  'failed' for eighth year as charity warns of 'devastating' impact

Chest, Heart and Stroke Scotland has warned that four in every ten stroke patients in Greater Glasgow & Clyde didn’t receive the necessary stroke care(NOT RECOVERY) last year.

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Stroke is still one of the biggest causes of long-term adult disability in Scotland.(Image: Julian Hamilton/Daily Miiror)

A charity has warned that Glasgow stroke patients are facing 'potentially devastating' outcomes after NHS treatment failed to meet Scottish Government targets for the eighth year in a row.

 Chest, Heart and Stroke Scotland has warned that four in every ten stroke patients in Greater Glasgow & Clyde didn’t receive the necessary stroke 

care(NOT RECOVERY)

 last year. It comes as the latest figures released by Public Health Scotland revealed that the country has failed to reach its target of 80 per cent of patients receiving an inpatient bundle for the eighth straight year.

The charity says that the stroke bundle, which includes aspirin, access to a stroke unit, brain imaging and swallow screening, gives patients the best chance of survival in the critical hours after a stroke. In Greater Glasgow & Clyde, 59.1 per cent of the region’s 2,454 patients received the bundle.

The charity says that across Scotland, 56 per cent of the 11,048 stroke patients received the 

care(NOT RECOVERY)

 set by national standards.

Joanne Graham, Director of Service Delivery at CHSS, said: “While we welcome the number of strokes dropping in Greater Glasgow & Clyde and the increase in people receiving the inpatient bundle, work remains to be done to achieve the Scottish Government’s 80% target.

“Unfortunately, this is the eighth straight year that the Scottish Government has failed to hit its own targets for stroke 

care(NOT RECOVERY)

. They are failing stroke survivors and our NHS colleagues in Greater Glasgow & Clyde who are doing the absolute best they can with the inadequate resources they’re currently being given. It’s having a potentially devastating impact on outcomes for stroke survivors in the region.

"We need the Scottish Government to build on today's marginal progress and continue driving better outcomes for people affected by stroke over the next five years.

"Investing in stroke services, rehabilitation and recovery support can improve quality of life, reduce disability and deliver long-term benefits for both patients and the wider health system. We know access to that support, as well as supported self management programmes and community services, can dramatically improve quality of life and help people regain independence.

"CHSS is already supporting stroke survivors across Scotland and we remain ready to build upon our current support in Greater Glasgow & Clyde to ensure more people can rebuild their lives after stroke, regardless of where they live or their circumstances."

Dr Claire Harrow, Deputy Medical Director for Acute Services at NHS Greater Glasgow and Clyde, said: "Across Greater Glasgow and Clyde we are committed to improving stroke 

care(NOT RECOVERY)

 for all our patients.(You're a complete fucking failure at that, so resign!)

“The stroke bundle covers a range of important aspects of 

care(NOT RECOVERY)

 for patients presenting with an acute stroke. Performance against each of these is monitored by each of our sector stroke teams focused on their own performance as well as areas for improvement and is overseen by the Stroke Improvement Group.

“Some of the developments in progress include extended weekday thrombolysis hours at Glasgow Royal Infirmary site, from 9am-5pm to 8am-7pm, from 17th August. We have also established a common stroke imaging pathway, and are working with the Scottish Ambulance Service to strengthen pre-alert processes so that patients are seen as promptly as possible on arrival.

“We are grateful for the ongoing hard work and commitment of the NHSGGC Stroke teams across the health board who continue to strive to deliver the best possible 

care(NOT RECOVERY)

 for stroke patients.”

Public Health Minister Maree Todd said: “We are focused on ensuring people who have had a stroke receive the best possible 

care(NOT RECOVERY)

 as quickly as possible to enable them to live longer, healthier and more independent lives.

“Whilst we have seen an improvement in stroke bundle performance, we know there is more to do, and we will continue to work with individual health boards to drive up standards of stroke 

care(NOT RECOVERY)

, for example, through funding hyperacute stroke nurses to identify patients earlier in their journey and through the stroke pathway.”Stroke is still one of the biggest causes of long-term adult disability in Scotland.

If you’re living with the effects of a chest, heart or stroke condition or Long Covid and are looking for advice and information, please contact Chest Heart & Stroke Scotland’s Advice Line on 0808 801 0899. You can also text ADVICE to 66777 or email adviceline@chss.org.uk.

AHA says new legislation would strengthen stroke care and prevention

 

This is EXACTLY HOW FUCKING USELESS THE AHA/ASA IS! Settling for 'care' rather than recovery! Once again NOT LISTENING TO SURVIVORS!

It needs to be destroyed and run by survivors!

AHA says new legislation would strengthen stroke care and prevention

The American Heart Association (AHA) and the American Stroke Association (ASA) are urging Congress to quickly advance new legislation to provide new federal funding for stroke research and education. The AHA said the bill will help improve outcomes for people affected by stroke nationwide.

The Stroke Act (S.5260), introduced in the U.S. Senate Aug. 5, would direct the federal government to study how stroke care(NOT RECOVERY!) is delivered in the United States and to fund efforts aimed at improving stroke treatment, data collection and public awareness. The bill would authorize the secretary of the U.S. Department of Health and Human Services, working with the National Institute of Neurological Disorders and Stroke, to conduct or support research on stroke care(NOT RECOVERY!) delivery. It would also authorize $3 million for research projects each year from 2027 through 2032.

The bill was introduced by Sen. Ben Ray Luján of New Mexico, a stroke survivor. Luján, a stroke survivor, outlined the bill publicly at a meeting with the University of New Mexico Hospital and Health Sciences leadership and staff last week. He told them the bill would improve stroke prevention, treatment, recovery, data collection and research. He also detailed how the bill would strengthen emergency response and rehabilitation services, expand access to care(NOT RECOVERY!) and help people recognize stroke symptoms so that they know when to seek lifesaving treatment.

“This legislation would increase our understanding of stroke care(NOT RECOVERY!), improve the quality of stroke treatment delivered to communities nationwide and ultimately save lives,” Nancy Brown, AHA CEO, said in a statement. “Someone dies of a stroke every 3 minutes and 14 seconds in the United States, yet many strokes can be prevented, and recognizing the warning signs can help save lives. We thank Sen. Luján for turning his personal experience with stroke into action by championing this legislation.”

The AHA said this bill would also support training for emergency medical personnel and healthcare providers, improve care(NOT RECOVERY!) coordination after stroke and expand the use of telestroke technologies to better connect patients to specialized stroke expertise, regardless of geography. In addition, it would work to build on existing infrastructure by requiring the national stroke registry to leverage established systems rather than create a duplicative reporting framework. AHA said this approach aligns closely with its Get With The Guidelines-Stroke quality improvement program.

The Stroke Act has been referred to the Committee on Health, Education, Labor and Pensions for further review.

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American Heart Association invests $5.2 million for stroke care across Wyoming

 Until we get survivors in charge; WE'LL ALWAYS GET CRAPOLA LIKE THIS! 'CARE' NOT RECOVERY! 

YOU better get involved so your children and grandchildren get better recovery than you did!

American Heart Association invests $5.2 million for stroke care across Wyoming

The American Heart Association and the Helmsley Charitable Trust are putting $5.2 million toward improving stroke care(NOT RECOVERY!) across Wyoming, where long distances can make getting treatment quickly a challenge.

The organizations funding the effort say the investment will help connect emergency crews, hospitals and rehabilitation teams so patients can get the right care(NOT RECOVERY!) faster.

"There are people who are having a stroke, which is a leading cause of disability and death in Wyoming," American Heart Association CEO Nancy Brown said. "We knew that this was an opportunity because a person's zip code shouldn't determine what kind of health outcomes they have."

Brown said the investment will help people recognize stroke warning signs and better connect EMS, hospitals and rehabilitation teams across the state.

For Briena Saner, who suffered a stroke while pregnant with her son Barett, that mission hits close to home.

"To me it's just an amazing opportunity for others that are living in a more rural area of the state," Saner said. "There are some people that are an hour away from the emergency room and every minute does matter when it comes to stroke care(NOT RECOVERY!)."

Stroke Act would strengthen stroke systems of care, prevention

 This is EXACTLY HOW FUCKING USELESS THE AHA/ASA IS! Settling for 'care' rather than recovery! Once again NOT LISTENING TO SURVIVORS!

It needs to be destroyed and run by survivors!

Stroke Act would strengthen stroke systems of care, prevention

The American Heart Association applauds legislation to support research, expand public education to improve outcomes for stroke patients nationwide WASHINGTON, D.C., August 5, 2026 — Congressional legislation introduced today would improve the quality of stroke care(NOT RECOVERY!) for patients across the country. Senator Ben Ray Luján (D-N.M.) introduced the Stroke Act, which would support stroke care(NOT RECOVERY!) research, establish a national stroke registry, strengthen systems of care(NOT RECOVERY!), improve access to rehabilitation and recovery services and expand public education and prevention efforts.

The American Heart Association, a relentless force changing the future of health for everyone everywhere, and the American Stroke Association, a division of the American Heart Association, urge Congress to quickly advance the legislation, which would help improve outcomes for people affected by stroke nationwide. The Stroke Act is cosponsored by Senate Minority Leader Chuck Schumer (D-N.Y.) and Senators Michael Bennet (D-Colo.), John Fetterman (D-Pa.), Jeanne Shaheen (D-N.H.), Martin Heinrich (D-N.M.), Adam Schiff (D-Calif.), Alex Padilla (D-Calif.), John Hickenlooper (D-Colo.), Tina Smith (D-Minn.) and Jacky Rosen (D-Nev.).

“This legislation would increase our understanding of stroke care(NOT RECOVERY!), improve the quality of stroke treatment delivered to communities nationwide and ultimately save lives,” said Nancy Brown, CEO of the American Heart Association. “Someone dies of a stroke every 3 minutes and 14 seconds in the United States, yet many strokes can be prevented, and recognizing the warning signs can help save lives. We thank Sen. Luján for turning his personal experience with stroke into action by championing this legislation.”

Each year, nearly 800,000 people in the United States experience a stroke, making stroke the fourth-leading cause of death in the nation. The Stroke Act would support research to improve stroke care(NOT RECOVERY!) delivery, identify gaps in prevention and treatment, establish a national stroke registry and strengthen coordination across the continuum of care(NOT RECOVERY!) — from emergency response through rehabilitation and recovery. The legislation authorizes federal investments in research, data collection, systems improvement and public education to help ensure more patients receive timely, evidence-based care(NOT RECOVERY!).

The legislation also would strengthen systems of stroke care(NOT RECOVERY!) and encourage the adoption of best practices to improve patient outcomes. The American Heart Association advocates for policies that help ensure people experiencing a stroke receive the right care(NOT RECOVERY!) at the right time and in the right setting. The bill would support training for emergency medical personnel and health care providers, improve care(NOT RECOVERY!) coordination after stroke and expand the use of tele-stroke technologies that connect patients to specialized stroke expertise regardless of geography. The legislation also seeks to build on existing infrastructure by requiring the national stroke registry to leverage established systems rather than create a duplicative new reporting framework. This approach aligns closely with the American Heart Association’s Get With The Guidelines®-Stroke quality improvement program, which collects standardized stroke care(NOT RECOVERY!) and outcomes data, supports quality improvement and benchmarking and engages a broad network of stroke centers and hospitals nationwide.

A stroke can happen to anyone, at any age, and recognizing the warning signs quickly can help people take action in moments that matter. The Stroke Act would establish funding for national public education and awareness campaigns to increase understanding of stroke prevention, risk factors and symptoms. The American Stroke Association encourages everyone to know the warning signs of stroke using B.E. F.A.S.T. — Balance loss, Eyes or vision changes, Face drooping, Arm weakness or Speech difficulty. If any of these signs appear suddenly, it's Time to call 911 immediately.

For Spanish-speaking communities, the Stroke Association also promotes R.Á.P.I.D.O., a culturally relevant stroke warning signs resource. The Stroke Association also launched DerrameCerebral.org, a Spanish-language website that provides stroke prevention, treatment and recovery resources specifically tailored to Hispanic and Latino communities.

Additional resources

• American Stroke Association website
• American Heart Association resource: Get With The Guidelines®
• Stroke resources in Spanish
• American Heart Association resource: B.E. F.A.S.T. Warning Signs
• American Stroke Association resource: Let’s talk about: Hispanic and Latino Americans and Stroke
• Research article: Stroke Risk Factor Status and Use of Stroke Prevention Medications Among Hispanic/Latino Adults in HCHS/SOL

###

About the American Heart Association
The American Heart Association is a relentless force for a world of longer, healthier lives. Dedicated to ensuring equitable health in all communities, the organization has been a leading source of health information for more than one hundred years. Supported by more than 35 million volunteers globally, we fund groundbreaking research, advocate for the public’s health, and provide critical resources to save and improve lives affected by cardiovascular disease and stroke. By driving breakthroughs and implementing proven solutions in science, policy, and care(NOT RECOVERY!), we work tirelessly to advance health and transform lives every day. Connect with us on heart.org, Facebook, X or by calling 1-800-AHA-USA1.   

About the American Stroke Association
The American Stroke Association is a relentless force for a world with fewer strokes and longer, healthier lives. We team with millions of volunteers and donors to ensure equitable health and stroke care(NOT RECOVERY!) in all communities. We work to prevent, treat and beat stroke by funding innovative research, fighting for the public’s health, and providing lifesaving resources. The Dallas-based association was created in 1998 as a division of the American Heart Association. To learn more or to get involved, call 1-888-4STROKE or visit stroke.org. Follow us on Facebook and X.

For Media Inquiries:
Arielle Beer: arielle.beer@heart.org  

For Public Inquiries: 1-800-AHA-USA1 (242-8721)
heart.org and stroke.org  

World Stroke Organization (WSO) rehabilitation certification program

 Useless! Where is the RECOVERY CERTIFICATION that survivors want? Since you're not doing anything survivors want, just turn it over to survivors so recovery protocols can be created!

World Stroke Organization (WSO) rehabilitation certification program

Jessica Nolan https://orcid.org/0000-0001-5802-2120 jessica.nolan@curtin.edu.au, Kwah Li Khim https://orcid.org/0000-0002-9809-9859, […], and 

Elizabeth A Lynch https://orcid.org/0000-0001-8756-1051+20View all authors and affiliations

OnlinOnlineFirst

https://doi.org/10.1177/17474930261463019

 

Abstract

Background:

Rehabilitation(NOT RECOVERY! That is how fucking incompetent the WSO is!) has been identified by the World Stroke Organization (WSO) as a key priority to reduce the global burden of stroke. Global access to rehabilitation('Access is useless if you don't have recovery protocols! Or are you OK with your tyranny of low expectations? Survivors aren't!) is inconsistent and is particularly limited in low-and-middle-income countries. Progress in rehabilitation has not been as well evidenced as progress in acute care(NOT RECOVERY!). The WSO certification program, which commenced in 2021, focuses on acute interventions. A rehabilitation certification program, applicable in both inpatient and outpatient rehabilitation settings, has been developed to complement the acute certification program to address global implementation of evidence-based stroke care(NOT RECOVERY!).

Aim:

To develop globally applicable, evidence-based, stroke rehabilitation recommendations and performance metrics for use in a stroke rehabilitation certification program.

Methods:

Strong recommendations were extracted from high-quality stroke rehabilitation Clinical Practice Guidelines, systematic reviews and syntheses of clinical practice guidelines, and from the defining criteria of the International Stroke Recovery and Rehabilitation Alliance (ISRRA) Centers of Clinical Excellence. The WSO Rehabilitation Implementation Committee led the development of the recommendations and invited input from three international, multidisciplinary consultation groups. Group 1 compared strong recommendations from the Australia/New Zealand Living Guidelines with other international guidelines to identify consistent, high-quality recommendations. Group 2 mapped recommendations from global guideline syntheses against the Australia/New Zealand Living Guidelines. Group 3 reviewed and adapted the ISRRA Center of Clinical Excellence recommendations. Recommendations were consolidated through consensus meetings involving representatives from each workgroup, including people from high, upper-middle, and lower-middle-income countries. Strong recommendations that were consistent across teams, alongside additional recommendations based on certainty of evidence, anticipated risk versus benefit, and relevance across settings, were included as patient-level recommendations in the implementation certification program. Service-level recommendations were generated through consensus or derived from existing guidelines. An implementation manual, outlining “what,” “who,” and “how,” as well as indicators to demonstrate performance of each recommendation, was developed to support clinical implementation and to facilitate assessment for certification. The criteria were piloted between November 2024 and September 2025 at 15 centers in six upper- and lower-middle-income countries (three continents) and subsequently refined. Expectations (mandatory or recommended) for each level of certification (Minimal, Essential and Advanced) were set post-pilot through rating strength of evidence, a series of group discussions and review of pilot data.

Results

Fifty-five recommendations were included. Nine recommendations address service-level indicators, and 46 address patient-level indicators. Service-level indicators address defining features of rehabilitation services that are not apparent in individual patient medical record audits. Patient-level indicators address management of swallowing impairment, nutrition and hydration, information provision and goal setting, amount and timing of rehabilitation, exercise and motor rehabilitation, visual function, communication, mood and cognition, management of complications, and discharge planning and support. An implementation manual complements the recommendations to guide clinical care(NOT RECOVERY!) and consistent assessment.

Conclusions

The WSO rehabilitation recommendations and performance metrics incorporate the most current evidence and have been refined following pilot-testing. The recommendations are globally relevant and support both resource-limited and high-income settings in participating in the rehabilitation certification program to advance international stroke rehabilitation delivery.

Impact of the triglyceride-glucose index on prognosis following endovascular therapy for acute ischemic stroke: effect modification by collateral circulation

 Prognosis DOES NOTHING to get survivors recovered! 
You need EXACT PROTOCOLS for that! When will you provide them?

You described an association but did NOTHING to solve the underlying problem of 100% recovery!  Until we get survivors in charge stroke research will continue to be useless for survivors. 

Impact of the triglyceride-glucose index on prognosis following endovascular therapy for acute ischemic stroke: effect modification by collateral circulation

• 

  Yishu Wang

• Q

  Qinyu Lei

• J

  Jiaqi Wang

• Y

  Yachao Lin

• L

  Liguo Xu *

• Department of Interventional Radiology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China

Abstract

Objective: 

To investigate the association between the triglyceride-glucose (TyG) index and 90-day functional outcome after endovascular therapy in patients with acute ischemic stroke, to evaluate the risk assessment performance of the TyG index combined with clinical variables, and to assess the effect-modifying role of collateral circulation in this association.

Methods: 

A retrospective analysis was conducted in 209 patients with acute ischemic stroke who underwent endovascular therapy at our hospital between October 2022 and December 2025. Multivariable logistic regression was performed to evaluate factors associated with poor functional outcome, defined as a modified Rankin Scale (mRS) score > 2 at 90 days. Interaction and stratified analyses were conducted to assess whether collateral circulation modified the association between the TyG index and clinical outcomes. Receiver operating characteristic (ROC) curves and the corresponding area under the curve (AUC) were used to evaluate the predictive performance of the TyG index combined with clinical variables. Differences in AUCs were compared using DeLong’s test. Calibration was assessed using the Hosmer-Lemeshow test, Brier score, and calibration curve, and internal validation was performed with 1,000 bootstrap resamples.

Results: 

A total of 209 patients were included, with 145 (69.4%) in the good functional outcome group (modified Rankin Scale [mRS] score≤2) and 64 (30.6%) in the poor functional outcome group (mRS > 2). Univariate analysis showed that the TyG index was significantly higher in the poor functional outcome group, and that sex, baseline National Institutes of Health Stroke Scale (NIHSS) score and collateral circulation status also differed significantly between the two groups (all p < 0.05). Multivariable logistic regression analysis showed that the TyG index was independently associated with poor functional outcome at 90 days after endovascular therapy (OR = 1.972, p < 0.001). A significant interaction was observed between the TyG index and collateral circulation (p = 0.012), suggesting a possible effect-modifying role of collateral circulation, and stratified analysis showed that this association appeared to be more pronounced in patients with poor collateral circulation. The combined risk assessment model showed good discriminative ability for poor functional outcome at 90 days (AUC = 0.834, sensitivity = 0.828, specificity = 0.731, DeLong’s test: p < 0.001), and the addition of the TyG index further improved the discriminative ability and assessment performance of the model.

Conclusion: 

The TyG index is an independent risk factor for poor 90-day functional outcome after endovascular therapy in patients with acute ischemic stroke. Collateral circulation may modify this association. The TyG index also improves the risk assessment performance of the combined risk model.

More at link.

Social and Environmental Determinants of Stroke Functional Outcome and Strategies to Reduce Inequities

 The strategy is simple; YOU CREATE EXACT 100% RECOVERY PROTOCOLS!

And you're too fucking stupid to see that! My god, you're the AHA/ASA! Put some survivors in charge, we'll get the work done!

Comeuppance is going to be a real bitch for you when you are the 1 in 4 per WHO that has a stroke!

Social and Environmental Determinants of Stroke Functional Outcome and Strategies to Reduce Inequities

• Social, economic, and environmental determinants of health play a major but underrecognized role in shaping stroke functional outcomes and recovery.
• Advances in acute stroke care(NOT RECOVERY!) alone are insufficient to eliminate disparities in recovery, as inequities in stroke functional outcome and secondary stroke prevention persist due to upstream, non-clinical factors.(Well then you don't have enough brains to see what can be accomplished! Here's my email:OC1Dean@gmail.com I can help with that!)
• Sustained improvements in stroke recovery and secondary prevention depend on organizational capacity, equitable implementation based on need, and supportive community and policy infrastructure, without which patient-level interventions are unlikely to be effective or durable.(NO! You need a strategy! It's as simple as that!)

Read the full article in Stroke »

AHA calls for lifelong brain health strategy to prevent cognitive decline

If you were actually a useful organization you would have built 100% stroke recovery protocols by your ASA division; but no, useless fucking press releases! Just another fucking failure of a stroke association! I'd fire everyone there and have it run by survivors; that would ensure excellence!

You can contact me at OC1dean@gmail.com and I can give you a strategy to follow!

AHA calls for lifelong brain health strategy to prevent cognitive decline

By Hugo Francisco de SouzaReviewed by Susha Cheriyedath, M.Sc.Apr 29 2026

From childhood stress and pollution to sleep, inflammation, and the gut microbiome, the AHA’s new framework shows why protecting brain health must begin long before old age.

Study: Brain Health Across the Life Span: A Framework for Future Studies: A Scientific Statement From the American Heart Association. Image Credit: Anton Vierietin / Shutterstock

In a recent American Heart Association scientific statement published in the journal Stroke, researchers outline the rationale for expanding brain health beyond vascular risk factors to a holistic, lifelong framework. The modernized framework emphasizes optimal cognitive, emotional, and behavioral functioning throughout the life course.The comprehensive scientific statement highlights that, with the global population of adults aged 65 and older expected to exceed 2 billion by 2050, identifying modifiable vascular and nonvascular contributors to brain health, cognitive decline, and neurodegeneration is a clinical priority.

It subsequently synthesizes current evidence on chronic inflammation, environmental toxicants, mental health disorders, and socioeconomic status (SES), while also addressing sleep, gut microbiome dysbiosis, early-life infection, and chronic medical conditions, describing their potential roles in shaping brain health and resilience and identifying strategies to mitigate their effects and enhance neural resilience.

Life Span Brain Health Background

Research on brain health and cognitive resilience, typically defined as the capacity for the brain to recover following an insult, is thought to be increasingly critical as records emphasize that global aging is driving the prevalence of late-life mental illness, illicit substance use, neurologic disorders, and cognitive decline.

While previous paradigms in the field focused heavily on the "neurovasculome," targeting stroke prevention and vascular dementia via the management of hypertension and diabetes, emergent research indicates that vascular factors do not typically emerge as primary drivers of overt stroke until young adulthood.

Consequently, the American Heart Association (AHA) 's 2021 agenda identified modifiable risk factors but documented that a more granular understanding of nonvascular contributions was urgently needed.

AHA Brain Health Statement Scope

This 2026 AHA scientific statement builds on the AHA's earlier brain health agenda by exploring how early-life exposures experienced during brain maturation can prime the central nervous system (CNS) for neurodegeneration and cognitive decline in older adults.

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This scientific statement is a comprehensive synthesis of years of transdisciplinary research that bridges neurology, psychiatry, and geroscience. Rather than reporting a single new analytical dataset, it reviews evidence from multiple scientific literatures, including:

• Large-scale longitudinal cohorts: Data from 6 European population-based birth cohorts (n = 9,482 children) were reviewed to assess the impact of prenatal air pollution on psychomotor development.

• Neuroimaging and molecular studies: Human neuroimaging and postmortem studies provided data on intracellular signaling, gene expression, and neuronal atrophy in the medial prefrontal cortex (mPFC) and hippocampus.

• Clinical meta-analyses: Evaluation of hazard ratios associated with ambient air pollutants and dementia risk across 14 distinct studies.

The statement also discusses evidence across preclinical, epidemiologic, clinical, and mechanistic studies, including brain-derived neurotrophic factor (BDNF) expression, beta-amyloid and tau pathology, gray matter volume, and the functional integrity of the blood-brain barrier.

Nonvascular Brain Health Risk Factors

The scientific statement identified several modifiable domains with varying strengths of supporting evidence that exert significant pressure on brain homeostasis: 1. Environmental toxicants, 2. Stress, depression, and anxiety, 3. Social determinants and toxic stress, 4. Gut microbiome and systemic inflammation, 5. Poor sleep quality, and 6. Early-life infection and chronic medical conditions.

Chronic exposure to PM2.5 (particulate matter with a diameter ≤ 2.5 µm) is now considered an important environmental factor associated with dementia risk. These findings draw from meta-analyses, which reported an overall hazard ratio per 2 µg/m3 of PM2.5 at 1.04 (95% confidence interval, 0.99–1.09).

Furthermore, prenatal NO2 (nitrogen dioxide) exposure was shown to be associated with a decrease of 0.68 points (95% confidence interval, −1.25 to −0.11) in global psychomotor development scores per 10 µg/m3 increase. Notably, approximately 26% of disability associated with ischemic stroke in adults is linked to air pollution.

The present data link depression and anxiety with biological pathways that may accelerate biological aging. Early-life depressive symptoms were found to correlate with a 2-fold or greater increase in dementia risk.

The biological mechanism driving this process may involve chronic stress, which induces sustained decreases in BDNF signaling, fostering synaptic loss, particularly in the mPFC and hippocampus. Unfortunately, current single-modality treatment remission rates for these conditions remain modest, ranging from 30% to 50%.

Adverse childhood experiences (ACEs) are now considered a prevalent condition, with 17.3% of US adults reporting ≥ 4 ACEs. Studies have shown that these experiences can trigger a "toxic stress response," leading to prolonged activation of the hypothalamic-pituitary-adrenal (HPA) axis and allostatic overload.

Finally, dysbiosis of the gut-brain axis has been associated with Alzheimer's disease (AD) and Parkinson's disease (PD), with evidence suggesting bidirectional gut-brain involvement rather than a fully established causal relationship in humans. The AHA emphasizes that high-fiber diets support the production of short-chain fatty acids (SCFAs), which modulate blood-brain barrier integrity and microglial activation and may support microbial diversity, reduce inflammation, and promote brain and cardiometabolic health.

Poor sleep quality was also highlighted as a life-course influence on brain health. Sleep supports brain maturation, memory consolidation, synaptic regulation, and glymphatic clearance of proteins, while inadequate sleep and obstructive sleep apnea are associated with cognitive decline, dementia risk, beta-amyloid and tau accumulation, and altered cerebral blood flow.

The statement further notes that early-life infections and chronic pediatric medical conditions, including congenital heart disease, sickle cell anemia, moyamoya, obesity, and infection-related stroke risks, can influence brain development, cognition, and mental health through vascular, inflammatory, metabolic, and psychosocial pathways.

Holistic Brain Health Prevention Strategies

The statement concludes that brain health must be managed through a holistic, life span approach that prioritizes early detection and personalized intervention. The AHA calls for individual, clinical, public health, and policy-level strategies, including regular physical activity, sleep hygiene to facilitate glymphatic clearance of beta-amyloid, and a polyphenol-rich or Mediterranean-style diet to reduce systemic inflammation.

Future research must focus on personalized, culturally responsive practices and the identification of CNS-specific biomarkers to extend cognitive longevity across all communities.

Journal reference:

• Marsh, E. B., et al. (2026). Brain Health Across the Life Span: A Framework for Future Studies: A Scientific Statement From the American Heart Association. Stroke. DOI – 10.1161/str.0000000000000518, https://www.ahajournals.org/doi/10.1161/STR.0000000000000518