Stroke Cases 2035

69,051

+84% from 2016

CIND Cases 2035

25,274

+126% from 2016

Dementia Cases 2035

12,442

+155% from 2016

These scenarios show how different levels of success in stroke prevention and treatment could affect future outcomes.

🔴 Stable Trends

What it means: Continue current prevention and treatment approaches

Result: 85,834 stroke cases (+46% from 2022)

Likelihood: High if no policy changes

🟡 Low Decline

What it means: Modest improvements in prevention (1% annual decline) and treatment (2.9% decline in deaths)

Result: 74,554 stroke cases (+26% from 2022)

Likelihood: Achievable with sustained effort

🟢 High Decline

What it means: Major prevention breakthroughs (2% annual decline) and treatment advances (4% decline in deaths)

Result: 59,660 stroke cases (+1% from 2022)

Likelihood: Requires significant investment

🔵 Decelerating Decline

What it means: Initial improvements that slow over time due to diminishing returns

Result: 81,774 stroke cases (+39% from 2022)

Likelihood: Most realistic scenario

Critical Finding

Even in the most optimistic scenario, post-stroke dementia cases will increase by 23% by 2046.

This shows Ireland must prepare for increased cognitive care needs regardless of prevention success.

Cognitive Impact

Only 27-28% of remaining life after stroke at age 50 is expected to be free from cognitive impairment.

This means most stroke survivors will experience thinking and memory problems.

Women live longer after stroke but spend a similar proportion of life with cognitive problems as men.

Both genders need long-term cognitive support services.

Planning Implications

Stroke survivors need: - Cognitive rehabilitation programs - Long-term support services - Family caregiver training - Adaptive technology and aids - Quality of life interventions

Investment Needed by 2035

€71.2M

For healthcare capacity expansion

Investment Needed by 2046

€116.2M

Total infrastructure investment

Economic Burden 2035

€2,147M

Total annual cost to society

Immediate Priorities (1-2 years)
  1. Audit current stroke services across all regions
  2. Develop workforce training programs for cognitive rehabilitation
  3. Establish stroke prevention campaigns targeting high-risk groups
  4. Create integrated care pathways linking acute and community care
  5. Secure funding commitments for service expansion
Medium-term Goals (3-7 years)
  1. Build additional stroke units and rehabilitation facilities
  2. Train specialized cognitive health professionals
  3. Implement population-based prevention programs
  4. Develop telemedicine networks for rural areas
  5. Establish research infrastructure for continuous monitoring
📈 75-89 Years: Highest Impact

This age group shows the largest absolute increases in all conditions:

  • Stroke: +156% by 2046
  • CIND: +240% by 2046
  • Dementia: +235% by 2046
Requires specialized geriatric stroke services
📊 65-74 Years: Fastest Growth

The “young-old” group shows fastest percentage growth:

  • Stroke: +194% by 2046
  • CIND: +314% by 2046
  • Dementia: +426% by 2046
Need early intervention programs
📋 40-64 Years: Working Age

Even working-age adults see significant increases:

  • Stroke: +56% by 2046
  • CIND: +75% by 2046
  • Dementia: +131% by 2046
Focus on return-to-work programs
What is the StrokeCog Model?

The StrokeCog Model is a sophisticated epidemiological computer model developed by researchers at RCSI University of Medicine and Health Sciences, Trinity College Dublin, and University of Liverpool.

Key Features:
  • Markov model tracking stroke survivors through different health states
  • Probabilistic analysis with uncertainty intervals
  • Age and sex-specific projections
  • Validated against independent data sources
  • Policy-relevant scenarios for healthcare planning
What Makes It Unique:
  • First model to comprehensively track cognitive outcomes after stroke
  • Includes both CIND (Cognitive Impairment No Dementia) and dementia
  • Projects life expectancy with quality of life measures
  • Evaluates alternative future scenarios based on prevention success
Data Sources Used
Irish Data:
  • TILDA (The Irish Longitudinal Study on Ageing)
  • NDPSS (North Dublin Population Stroke Study)
  • Hospital Episode Statistics (HIPE)
  • Central Statistics Office population data
  • Irish nursing home survey data
International Data:
  • ELSA (English Longitudinal Study on Ageing)
  • OXVASC (Oxford Vascular Study)
  • Published systematic reviews and meta-analyses
  • International epidemiological studies
Why Multiple Sources?

Using multiple data sources increases reliability and allows for sensitivity analysis to test how robust the findings are to different assumptions.

How We Know the Model Works
Validation Methods:
  1. External validation against official stroke mortality statistics (2017-2022)
  2. Cross-validation with hospital discharge data
  3. Comparison with alternative modeling approaches
  4. Sensitivity analysis testing 24+ different scenarios
  5. Expert review by stroke clinicians and epidemiologists
Key Validation Results:
  • Model predictions closely matched observed stroke deaths
  • Hospital discharge projections were within uncertainty intervals
  • Results were robust to different assumptions about cognitive definitions
  • Conservative estimates - likely underestimating true burden
Uncertainty:

All projections include 95% uncertainty intervals showing the range of plausible outcomes.

Published Research
Primary Publications:

  1. Sexton E, et al. (2021). StrokeCog Markov Model: Projected Prevalent and Incident Cases of Stroke and Poststroke Cognitive Impairment to 2035 in Ireland. Stroke 52:3961-3969.

  2. Sexton E, et al. (2025). Forecasting stroke and stroke-driven dementia in a rapidly ageing population: a model-based analysis of alternative projection scenarios for Ireland. BMJ Open 15:e091557.

Funding: Health Research Board Ireland

Key Assumptions
  1. Cognitive decline doesn’t improve spontaneously after 1 year post-stroke
  2. Ongoing risk of cognitive deterioration over time
  3. Recurrent stroke accelerates cognitive decline
  4. Age-specific rates remain stable unless specified otherwise
  5. International data (England) applicable to Irish population
Sensitivity Testing

All assumptions were tested with alternative scenarios to ensure robust conclusions.

Important Limitations
  1. Conservative estimates - likely underestimates true burden due to study participation bias
  2. Cognitive assessment based on research tests, not clinical diagnosis
  3. Small sample sizes for some transition probabilities
  4. Assumes stability in treatment effectiveness over time
  5. Does not model potential breakthrough treatments

These limitations mean projections may be conservative - actual needs could be higher.

For Healthcare Planners
  • Use range estimates rather than point estimates
  • Plan for higher-end scenarios to avoid under-capacity
  • Focus on trends and proportional increases rather than exact numbers
  • Consider lead times needed for service development
  • Use for strategic planning, not operational details
  • Understand these are projections, not predictions
  • Lifestyle changes can reduce individual stroke risk
  • Early recognition of stroke symptoms saves lives and function
  • Support research into stroke prevention and treatment

Research Team Lead:
Dr. Eithne Sexton, RCSI University
📧 eithnesexton@rcsi.ie

For technical details:
Model code and data available at: https://osf.io/j9a6z/

For stroke information:
Irish Heart Foundation: https://irishheart.ie/