School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia (R.J.S., T.M., J.E.C.).
School of Psychology and Public Health, La Trobe University, Bundoora, Australia (D.K.W.).
Stroke. 2021 Jan;52(2):748-760. doi: 10.1161/STROKEAHA.120.032215. Epub 2021 Jan 25.
This systematic review and meta-analysis aimed to investigate whether cognition is associated with activity and participation outcomes in adult stroke survivors. Five databases were systematically searched for studies investigating the relationship between general- and domain-specific cognition and longer-term (>3 months) basic activities of daily living (ADL), instrumental ADLs, and participation outcomes. Eligibility for inclusion, data extraction, and study quality was evaluated by 2 reviewers using a standardized protocol. Effect sizes () were estimated using a random-effects model. Sixty-two publications were retained for review, comprising 7817 stroke survivors (median age 63.57 years, range:18-96 years). Median length of follow-up was 12 months (range: 3 months-11 years). Cognition (all domains combined) demonstrated a significant medium association with all 3 functional outcomes combined, =0.37 (95% CI, 0.33-0.41), <0.001. Moderator analyses revealed these effects persisted regardless of study quality, order in which outcomes were collected (sequential versus concurrent), age, sample size, or follow-up period. Small to medium associations were also identified between each individual cognitive domain and the separate ADL, instrumental ADL, and participation outcomes. In conclusion, poststroke cognitive impairment is associated with early and enduring activity limitations and participation restrictions, and the association is robust to study design factors, such as sample size, participant age, follow-up period, or study quality. Cognitive assessment early poststroke is recommended to facilitate early detection of disability, prediction of functional outcomes, and to inform tailored rehabilitation therapies.
本系统评价和荟萃分析旨在探讨认知是否与成年脑卒中幸存者的活动和参与结果相关。系统地检索了五个数据库，以研究一般认知和特定领域认知与长期（>3 个月）基本日常生活活动（ADL）、工具性日常生活活动和参与结果之间的关系。两名审查员使用标准化方案评估纳入标准、数据提取和研究质量。使用随机效应模型估计效应大小（）。保留了 62 篇出版物进行综述，其中包括 7817 名脑卒中幸存者（中位数年龄 63.57 岁，范围：18-96 岁）。中位随访时间为 12 个月（范围：3 个月-11 年）。认知（所有领域合并）与所有 3 项功能结果均显示出显著的中等关联，=0.37（95%CI，0.33-0.41），<0.001。 调节分析表明，无论研究质量、结果收集顺序（先后顺序与同时收集）、年龄、样本量或随访时间如何，这些影响都持续存在。还发现每个单独的认知域与单独的 ADL、工具性 ADL 和参与结果之间存在小到中等关联。总之，脑卒中后认知障碍与早期和持久的活动受限和参与受限相关，且该关联不受研究设计因素（如样本量、参与者年龄、随访时间或研究质量）的影响。建议在脑卒中后早期进行认知评估，以促进早期发现残疾、预测功能结果，并为制定个性化康复治疗提供依据。
