AHA/ASA Vice Chair of the International Stroke Conference and volunteer expert, Louise McCullough, M.D., offers perspective (via Zoom) on ISC 20 presentation WP482. She is professor and chair of the Department of Neurology at McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth); Chief of Neurology Service at Memorial Hermann Hospital – Texas Medical Center.
copyright American Heart Association 

"It's a very well-done abstract, that found that if you lived in the stroke belt, which is a group of states, Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, and Tennessee, that if you live in those states, in the stroke belt, as a young adult or child, that you had a higher risk of cognitive impairments in adulthood and cognitive decline. This is true even if you moved out of the state after your childhood into a non-stroke belt state, that risk seems to have followed you throughout your lifespan. So if you spent any part of your childhood in the stroke belt, you carry that risk even if you move out of the stroke belt. So that's a very interesting finding, and it's again, it's epidemiological work so it's really unclear why this risk is patterned in early life. We are starting to realize that many risk factors can be carried with you lifelong, that are even things like exposures in childhood. And it seems to be very similar to what's been seen for multiple sclerosis, where you're much more likely to develop multiple sclerosis, if you live in the northern latitudes. And if you grew up in the northern latitudes, your risk for MS remains high. It seems to be the same for cognitive impairment and stroke. If you grew up in a high risk environment, the stroke belt, you are likely to have that risk long term throughout your lifespan. This is important, because if you did happen to grow up in those, you have to probably be even more rigorously controlling your risk factors. And at this point, because it's an association, not a causation, we don't really know why this risk occurs. It could be something due to genetics. It could be more genetic risk factors in the population that's born in that stroke belt's. It could be epigenetic factors, early life exposures, or other factors that can pattern your risk for your entire lifespan."