People living with severe mental illness face a substantially higher risk of dementia throughout adulthood, as well as a significantly elevated risk of stroke in early and middle adulthood, according to a large new study based on health records from Catalonia, Spain. The findings, published in the September 2026 edition of the peer-reviewed journal European Neuropsychopharmacology, suggest that physical health risks linked to severe psychiatric conditions emerge much earlier than many clinicians may expect, underscoring the need for general health care to be more integrated in mental health care.
The researchers examined records from nearly 700,000 people, including about 177,000 people diagnosed with of schizophrenia, bipolar disorder, or major depression, and around 517,000 without a psychiatric diagnosis. By comparing rates of dementia and stroke across age groups from 20 to 99, the team found a significant association between severe mental illness and dementia at every age studied. The link between severe mental illness and increased stroke risk was especially marked in early and middle adulthood. Adults aged 30 to 39 with severe mental illness, showed more than 20 times increased odds of having dementia compared with those without a psychiatric diagnosis. Co-lead author*, Dr Michele De Prisco (of the Hospital Clínic-IDIBAPS and University of Barcelona, Catalonia) said:
"Although dementia remains rare in that 30 to 39 age group overall, the size of the difference associated with mental illness was notable. For every 100,000 people without a severe mental illness, about 24 had dementia at ages 30-39, compared with about 550 among those with a severe mental illness"
This translates to 20-fold higher odds of dementia compared with controls, despite the very low dementia prevalence in this age group (0.55% in Severe Mental Illness vs. 0.02% in controls). In older adults aged 80 to 89, people with severe mental illness still had roughly four times the odds of dementia. For stroke, adults aged 40 to 49 with severe mental illness had nearly three times the odds of ischemic stroke compared with controls".
He continued, "One of the most important contributions of our findings is to raise awareness that conditions such as dementia and stroke, which in clinical practice are often thought of as problems of old age, can also emerge in people who are much younger. That should put clinicians on alert".
Mental illness affects around a billion people, with severe mental illness (such as schizophrenia, bipolar disorder, and major depression) affecting at least 300m people worldwide. The authors say these huge numbers support a more integrated approach to treatment, in which psychiatric care is paired with regular monitoring of neurological and cardiovascular health.
Dr De Prisco said: "These findings reinforce the need to think about severe mental illness as a whole-person health issue, not only a mental health diagnosis. What we are seeing is that risks linked to subsequent dementia and stroke may appear much earlier in life than many people expect, which means prevention, monitoring and coordinated care should also begin earlier".
The study was cross-sectional, meaning it provides a snapshot rather than tracking individuals over time; so it shows an association rather than cause and effect. Dr De Prisco said "Our next step is to set up longitudinal studies, where we follow individual patients over time. We also need to develop systems to integrate mental health and physical care, and then to test that these systems are effective".
Commenting, Professor Kamilla Miskowiak (University of Copenhagen) said:
"These findings highlight the importance of considering cognitive and brain health as key treatment targets in people with severe mental illness. Cognitive impairment affects most people with schizophrenia and around half of individuals with bipolar disorder and major depression, often even when psychiatric symptoms are stable. The increased risks of dementia and stroke reported in this study emphasise the need to screen for cognitive decline and to identify and address modifiable risk factors, including cardiovascular health problems, as part of routine clinical care. While evidence-based interventions such as cognitive remediation can improve cognitive functions, there remains an urgent need for more effective treatments targeting cognition. Better integration of mental, cognitive, and physical health care could help improve both quality of life and long-term health outcomes for these patients".
Professor Miskowiak was not involved in this research, this is an independent comment.
Notes
*Dr De Prisco is co-lead author with Dr Vincenzo Oliva.
This paper is published in the September edition of the peer-reviewed journal European Neuropsychopharmacology. It can be found at https://www.sciencedirect.com/science/article/pii/S0924977X2600091X This is open-access.
Paper "Age-stratified associations between severe mental illness, dementia, and ischemic stroke: findings from the PADRIS-PRESTO cohort".
European Neuropsychopharmacology , Volume 110 , September 2026, 112850. https://doi.org/10.1016/j.euroneuro.2026.112850
European Neuropsychopharmacology is an official journal of the ECNP, which is Europe's largest applied neuroscience organisation, www.ecnp.eu The ECNP annual congress takes place in October in Munich, with around 7,500 attendees anticipated.
This work received no specific financial support, other than from the IDIBAPS Translational Research Programme for Brain Disorders,
