La Trobe University, Melbourne, VIC, Australia.
University of Melbourne, Melbourne, Australia.
Neurorehabil Neural Repair. 2021 Jul;35(7):585-600. doi: 10.1177/15459683211017501. Epub 2021 May 22.
Cognition affects poststroke recovery, but meta-analyses of cognition have not yet provided a comparison of observational and intervention evidence.
To describe the trajectory of poststroke cognition and the factors that moderate it across intervention and observational cohorts.
Six databases were searched up to January 2020. Studies describing quantitative changes in cognition in adults poststroke were included. Interventions were classified into pharmacological, therapist-led, nonroutine/alternative, and usual care. Summary estimates were compared via hierarchical mixed-effects models. Age, recovery stage, stroke etiology, cognitive domain targeted in studies, and intervention types were investigated as moderators of cognition. Recovery stage and intervention were further analyzed in a multiplicative metaregression model.
A total of 43 intervention trials and 79 observation cohorts involving 28 222 stroke participants were included. Heterogeneity was significant (τ = 0.09; CI = 0.01-0.21, < .001) with no evidence of publication bias. Cognitive recovery was greater in intervention trials ( = 0.47; CI = 0.37-0.58) than observational cohorts ( = 0.28; CI = 0.20-0.36) across all moderators analyzed. Nonroutine/alternative and pharmacological trials achieved the best overall results ( = 0.57, CI = 0.42-0.73, and = 0.52, CI = 0.30-0.74, respectively), followed by therapist-led ( = 0.46; CI = 0.17-0.74), and usual care ( = 0.28; CI = 0.11-0.45) interventions. Medium recovery effects (ie, ≥ 0.5) were observed in examining first-ever stroke, executive function, visuo-perceptual, consciousness, and psychomotor skills, 61 to 180 days poststroke, in participants aged 65 to 70 years.
Cognitive recovery is possible using different controlled interventions in all recovery stages, with smaller benefits ≥2 years poststroke. Longer-term studies are needed to determine the role of nonroutine/alternative therapies and the association between cognitive recovery and performance in everyday activities.
认知能力影响卒中后恢复，但认知的荟萃分析尚未对观察性研究和干预性研究的证据进行比较。
描述卒中后认知能力的轨迹，以及在干预和观察队列中影响其轨迹的因素。
检索了六个数据库，截止日期为 2020 年 1 月。纳入描述成人卒中后认知能力定量变化的研究。干预措施分为药物治疗、治疗师主导、非常规/替代治疗和常规护理。通过分层混合效应模型比较汇总估计值。年龄、恢复阶段、卒中病因、研究中针对的认知域以及干预类型被视为认知能力的调节因素。进一步在乘法荟萃回归模型中分析恢复阶段和干预措施。
共纳入 43 项干预试验和 79 项观察队列，涉及 28222 名卒中参与者。异质性显著（τ=0.09；CI=0.01-0.21，<.001），无发表偏倚证据。与观察队列（ = 0.28；CI=0.20-0.36）相比，干预试验中的认知恢复更大（ = 0.47；CI=0.37-0.58），在所有分析的调节因素中均如此。非常规/替代治疗和药物治疗试验的总体效果最好（ = 0.57，CI=0.42-0.73， = 0.52，CI=0.30-0.74），其次是治疗师主导的治疗（ = 0.46；CI=0.17-0.74）和常规护理（ = 0.28；CI=0.11-0.45）干预措施。在检查首发卒中、执行功能、视知觉、意识和精神运动技能、卒中后 61-180 天、65-70 岁年龄的参与者时，观察到中等程度的恢复效果（即≥0.5）。需要进行更长期的研究来确定非常规/替代疗法的作用以及认知恢复与日常生活活动表现之间的关系。
