Evidence mapPaperPMID 41847759Full record

ReviewStroke2026

Midlife as the Critical Window for Women's Stroke and Dementia Prevention: Pivotal Advances and Implementation Priorities.

Aleksandra Pikula, Sharon Iziduh, Emine Kocabas, Evy Reinders, Ana Claudia de Souza, Sanjula D Singh

Abstract readReview
In one paragraph

Review in Stroke, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Aleksandra PikulaDivision of Neurology, Department of Medicine, University of Toronto, ON, Canada (A.P.).ORCID 0000-0001-7077-0148
Sharon IziduhJay and Sari Sonshine Centre, University Health Network, Toronto, ON, Canada (A.P., S.I., E.K.).ORCID 0000-0003-2177-4999
Emine KocabasJay and Sari Sonshine Centre, University Health Network, Toronto, ON, Canada (A.P., S.I., E.K.).
Evy ReindersBrain Care Labs, Massachusetts General Hospital, Boston (E.R., S.D.S.).ORCID 0009-0002-1455-3477
Ana Claudia de SouzaDepartment of Neurology and Neurosurgery, Hospital Moinhos de Vento, Porto Alegre, Brazil (A.C.S.).ORCID 0000-0002-8722-9988
Sanjula D SinghBrain Care Labs, Massachusetts General Hospital, Boston (E.R., S.D.S.).ORCID 0000-0001-9304-8107

Funding

American Heart Association-American Stroke Association 812095
6 · The paper itself

Abstract

Women face a higher lifetime risk of stroke and dementia than men, yet prevention strategies are not optimally implemented for women. Midlife (ages 40-65) represents a critical yet underused life stage window for prevention. This period encompasses the menopausal transition, when hormonal, metabolic, vascular, and neurological changes converge. Despite this, women remain underrepresented in stroke trials, and sex-specific risk factors are poorly integrated into routine prevention. This review synthesizes the transformative advances in midlife women's stroke and vascular dementia prevention from 2015 to 2025, drawing on evidence from clinical guidelines, cohort studies, neuroimaging studies, randomized trials, and implementation research. It highlights research priorities and an implementation framework for the future. Six major advances were identified: first, the 2024 American Heart Association/American Stroke Association guidelines introduced a class I recommendation to screen for adverse pregnancy outcomes. Second, neuroimaging now demonstrates that adverse pregnancy outcomes are linked to vascular brain injury decades after they occur. Third, the 2020 American Heart Association statement established menopausal transition as a distinct cardiometabolic and neurobiological transition affecting vascular brain health. Fourth, menopause hormone therapy controversies have resolved through evidence supporting personalized, timing-based approaches. Fifth, inflammatory and lipid biomarkers measured in midlife can predict stroke risk years out. Sixth, postmenopausal women show greater vascular benefits from physical activity. Despite these advances, women do not routinely receive appropriate screening or prevention recommendations. These findings support a comprehensive midlife assessment that incorporates reproductive history, menopausal transition status, and novel biomarkers alongside traditional risk factors, and should be offered streamlined recommendations for lifestyle strategies and menopause hormone therapy when indicated. Closing the implementation gap will require health system adaptation, provider education, and embedded pragmatic trials to incorporate these advances into routine care.

Indexed as

DementiaDementia, VascularMenopauseStrokeFemaleHumansMiddle AgedRisk FactorsWomen's Healthincidenceneuroimagingpostmenopausequality of liferisk factors

Identifiers

PMID41847759
PMCPMC13110453

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.