Royal College of Surgeons in Ireland
The StrokeCog model of stroke and cognitive impairment.pdf (9.56 MB)

StrokeCog Markov model: projected prevalent and incident cases of stroke and poststroke cognitive impairment to 2035 in Ireland

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journal contribution
posted on 2022-04-28, 16:39 authored by Eithne SextonEithne Sexton, Nora-Ann Donnelly, Niamh Merriman, Anne HickeyAnne Hickey, Maev-Ann Wren, Martin O’Flaherty, Piotr Bandosz, Matia Guzman-Castillo, David WilliamsDavid Williams, Frances HorganFrances Horgan, Niall PenderNiall Pender, Joanne Feeney, Céline de Looze, Rose Anne Kenny, Peter Kelly, Kathleen BennettKathleen Bennett

Background and purpose: Cognitive impairment no dementia (CIND) and dementia are common stroke outcomes, with significant health and societal implications for aging populations. These outcomes are not included in current epidemiological models. We aimed to develop an epidemiological model to project incidence and prevalence of stroke, poststroke CIND and dementia, and life expectancy, in Ireland to 2035, informing policy and service planning.

Methods: We developed a probabilistic Markov model (the StrokeCog model) applied to the Irish population aged 40 to 89 years to 2035. Data sources included official population and hospital-episode statistics, longitudinal cohort studies, and published estimates. Key assumptions were varied in sensitivity analysis. Results were externally validated against independent sources. The model tracks poststroke progression into health states characterized by no cognitive impairment, CIND, dementia, disability, stroke recurrence, and death.

Results: We projected 69 051 people with prevalent stroke in Ireland in 2035 (22.0 per 1000 population [95% CI, 20.8-23.1]), with 25 274 (8.0 per 1000 population [95% CI, 7.1-9.0]) of those projected to have poststroke CIND, and 12 442 having poststroke dementia (4.0 per 1000 population [95% CI, 3.2-4.8]). We projected 8725 annual incident strokes in 2035 (2.8 per 1000 population [95% CI, 2.7-2.9]), with 3832 of these having CIND (1.2 per 1000 population [95% CI, 1.1-1.3]), and 1715 with dementia (0.5 per 1000 population [95% CI, 0.5-0.6]). Life expectancy for stroke survivors at age 50 was 23.4 years (95% CI, 22.3-24.5) for women and 20.7 (95% CI, 19.5-21.9) for men.

Conclusions: This novel epidemiological model of stroke, poststroke CIND, and dementia draws on the best available evidence. Sensitivity analysis indicated that findings were robust to assumptions, and where there was uncertainty a conservative approach was taken. The StrokeCog model is a useful tool for service planning and cost-effectiveness analysis and is available for adaptation to other national contexts.


Health Research Board (HRB) in Ireland under grant no. ICE-2015-1048 and award RL-15-1579



The original article is available at

Published Citation

Sexton E. et al. StrokeCog Markov model: projected prevalent and incident cases of stroke and poststroke cognitive impairment to 2035 in Ireland. Stroke. 2021;52(12):3961-3969

Publication Date

9 September 2021

PubMed ID



  • Beaumont Hospital
  • Data Science Centre
  • Health Psychology
  • Medicine
  • School of Physiotherapy

Research Area

  • Vascular Biology
  • Population Health and Health Services
  • Neurological and Psychiatric Disorders


Lippincott Williams & Wilkins


  • Accepted Version (Postprint)