Contador Israel, Alzola Patricia, Stern Yaakov, de la Torre-Luque Alejandro, Bermejo-Pareja Félix, Fernández-Calvo Bernardino
Department of Basic Psychology, Psychobiology and Methodology of Behavioral Sciences, University of Salamanca, Spain; 'Hospital del Mar' Medical Research Institute, Barcelona, Spain.
Department of Basic Psychology, Psychobiology and Methodology of Behavioral Sciences, University of Salamanca, Spain.
Ageing Res Rev. 2023 Feb;84:101814. doi: 10.1016/j.arr.2022.101814. Epub 2022 Dec 5.
To conduct a systematic review and meta-analyses of the effect of socio-behavioral cognitive reserve (CR) proxies on cognitive decline after stroke.
Three journal search and indexing databases (PubMed, Scopus and Web of Sciences) were crossed to examine the scientific evidence systematically. In addition, meta-analytic techniques, using mixed-effect methods, were carried out to estimate the impact (pooled effect size) of CR proxies on either dementia incidence or cognitive decline after stroke.
Twenty-two studies were included in the systematic revision, whereas nineteen of them were eligible for the meta-analysis. The findings showed that high education is associated with a decreased rate of post-stroke dementia. Moreover, other CR proxies (e.g., occupation, bilingualism or social interaction) demonstrate a protective effect against non-dementia cognitive decline after stroke, although some inconsistencies were found in the literature. Regarding the meta-analysis, occupational attainment and education) showed a protective effect against post-stroke cognitive impairment diagnosis in comparison with a mixed category of different CR proxies. Second, a main cognitive change effect was found, pointing to greater cognitive change after stroke in those with low vs. high CR.
Our findings emphasize that CR may prevent cognitive decline after stroke, but this effect can be modulated by different factors such the CR proxy and individual characteristics such as age or type of lesion. The methodological divergences of the studies (i.e., follow-up intervals, cognitive outcomes) need unification to diminish external sources of variability for predicting rates of cognitive decline after stroke.
对社会行为认知储备（CR）代理指标对中风后认知衰退的影响进行系统评价和荟萃分析。
交叉检索三个期刊检索和索引数据库（PubMed、Scopus和Web of Sciences）以系统地审查科学证据。此外，采用混合效应方法进行荟萃分析技术，以估计CR代理指标对中风后痴呆发病率或认知衰退的影响（合并效应量）。
系统评价纳入了22项研究，其中19项符合荟萃分析的条件。研究结果表明，高学历与中风后痴呆发病率降低有关。此外，其他CR代理指标（如职业、双语能力或社交互动）对中风后的非痴呆性认知衰退具有保护作用，尽管文献中存在一些不一致之处。关于荟萃分析，与不同CR代理指标的混合类别相比，职业成就和教育程度对中风后认知障碍诊断具有保护作用。其次，发现了一个主要的认知变化效应，表明中风后低CR组比高CR组的认知变化更大。
我们的研究结果强调，CR可能预防中风后的认知衰退，但这种效应可能会受到不同因素的调节，如CR代理指标以及年龄或病变类型等个体特征。研究的方法差异（即随访间隔、认知结果）需要统一，以减少预测中风后认知衰退率的外部变异来源。
