Tao Chunhua, Yuan Yuan, Xu Yijun, Zhang Song, Wang Zheng, Wang Sican, Liang Jingyan, Wang Yingge
Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, China.
School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China.
Front Neurol. 2023 Feb 22;14:1100469. doi: 10.3389/fneur.2023.1100469. eCollection 2023.
This systematic review was performed to identify the role of cognitive reserve (CR) proxies in the functional outcome and mortality prognostication of patients after acute ischemic stroke.
PubMed, Embase, Web of Science, and Cochrane Library were comprehensively searched by two independent reviewers from their inception to 31 August 2022, with no restrictions on language. The reference lists of reviews or included articles were also searched. Cohort studies with a follow-up period of ≥3 months identifying the association between CR indicators and the post-stroke functional outcome and mortality were included. The outcome records for patients with hemorrhage and ischemic stroke not reported separately were excluded. The Quality In Prognosis Studies (QUIPS) tool was used to assess the quality of included studies.
Our search yielded 28 studies ( = 1,14,212) between 2004 and 2022, of which 14 were prospective cohort studies and 14 were retrospective cohort studies. The follow-up period ranged from 3 months to 36 years, and the mean or median age varied from 39.6 to 77.2 years. Of the 28 studies, 15 studies used the functional outcome as their primary outcome interest, and 11 of the 28 studies included the end-point interest of mortality after ischemic stroke. In addition, two of the 28 studies focused on the interest of functional outcomes and mortality. Among the included studies, CR proxies were measured by education, income, occupation, premorbid intelligence quotient, bilingualism, and socioeconomic status, respectively. The quality of the review studies was affected by low to high risk of bias.
Based on the current literature, patients with ischemic stroke with higher CR proxies may have a lower risk of adverse outcomes. Further prospective studies involving a combination of CR proxies and residuals of fMRI measurements are warranted to determine the contribution of CR to the adverse outcome of ischemic stroke.
PROSPERO, identifier CRD42022332810, https://www.crd.york.ac.uk/PROSPERO/.
进行这项系统评价以确定认知储备（CR）替代指标在急性缺血性脑卒中患者功能结局和死亡预后中的作用。
两名独立评审员对PubMed、Embase、Web of Science和Cochrane图书馆进行了全面检索，检索时间从建库至2022年8月31日，无语言限制。还检索了综述或纳入文章的参考文献列表。纳入随访期≥3个月、确定CR指标与卒中后功能结局和死亡率之间关联的队列研究。排除未分别报告出血性和缺血性脑卒中患者结局记录的研究。采用预后研究质量（QUIPS）工具评估纳入研究的质量。
我们的检索在2004年至2022年间产生了28项研究（n = 114212），其中14项为前瞻性队列研究，14项为回顾性队列研究。随访期从3个月到36年不等，平均或中位年龄从39.6岁到77.2岁不等。在这28项研究中，15项研究将功能结局作为其主要结局关注点，28项研究中的11项纳入了缺血性脑卒中后死亡率的终点关注点。此外，28项研究中的两项关注功能结局和死亡率。在纳入的研究中，CR替代指标分别通过教育程度、收入、职业、病前智商、双语能力和社会经济地位来衡量。综述研究的质量受到低到高偏倚风险的影响。
基于当前文献，具有较高CR替代指标的缺血性脑卒中患者不良结局风险可能较低。有必要进一步开展涉及CR替代指标与功能磁共振成像测量残差相结合的前瞻性研究，以确定CR对缺血性脑卒中不良结局的影响。
PROSPERO，标识符CRD42022332810，https://www.crd.york.ac.uk/PROSPERO/ 。
