Binning Lauren, Basquill Catriona, Tvrda Lucie, Quinn Terry
School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
Older People's Service, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK.
Cerebrovasc Dis. 2025;54(4):536-547. doi: 10.1159/000541670. Epub 2024 Sep 30.
Cognitive frailty and the related concepts of cognitive reserve and imaging-based brain frailty are of increasing interest in older adult care. However, there is uncertainty regarding their importance within a stroke population. We aimed to establish the prevalence of cognitive frailty and reserve in stroke and determine impact on outcomes.
We conducted a systematic review across multidisciplinary electronic databases using validated search syntax. The protocol for this review has been published (PROSPERO, CRD42023433385). We identified studies on cognitive frailty and cognitive reserve, including studies that used related concepts. We extracted data to inform estimates of prevalence and associations with outcomes of physical function, cognition and quality of life, performing meta-analyses where possible. Risk of bias was assessed using Newcastle-Ottawa tools appropriate to study design.
Our search returned 12,095 studies, from which 14 papers met our criteria. No studies described cognitive frailty, and rather studies described cognitive reserve and brain frailty. Cognitive reserve was assessed using proxy measures of education, employment, and leisure time. Four studies used the Cognitive Reserve Index Questionnaire (CRIq) with pooled estimate score of 103.25, 95% CI: 96.87-109.65 (indicating moderate cognitive reserve). Cognitive reserve had varying associations with post-stroke outcomes, three studies (n = 7,759 participants) reporting significant negative association with cognitive measures. Brain frailty was assessed using imaging markers. Across four studies (n = 3,086 participants), pooled prevalence of brain frailty was 73.8%, 95% CI: 72.2-75.3. Higher brain frailty was associated with poorer post-stroke outcomes for majority of studies assessed. Seven studies (50%) were scored as low risk of bias.
Attempts to synthesise these data were complicated by inconsistency in terminology and heterogeneity in methods. However, our findings suggest that brain frailty is common in stroke and associated with poorer outcomes. The epidemiology of cognitive frailty and reserve is less well described. All these measures may be useful for prognostication in stroke, but there are multiple areas where more research is needed.
认知衰弱以及相关的认知储备和基于影像学的脑衰弱概念在老年护理中越来越受到关注。然而，它们在中风人群中的重要性尚不确定。我们旨在确定中风患者中认知衰弱和储备的患病率，并确定其对预后的影响。
我们使用经过验证的搜索语法在多学科电子数据库中进行了系统综述。该综述的方案已发表（PROSPERO，CRD42023433385）。我们确定了关于认知衰弱和认知储备的研究，包括使用相关概念的研究。我们提取数据以估计患病率以及与身体功能、认知和生活质量结果的关联，并在可能的情况下进行荟萃分析。使用适合研究设计的纽卡斯尔 - 渥太华工具评估偏倚风险。
我们的搜索返回了12,095项研究，其中14篇论文符合我们的标准。没有研究描述认知衰弱，而是描述了认知储备和脑衰弱。认知储备通过教育、就业和休闲时间的替代指标进行评估。四项研究使用了认知储备指数问卷（CRIq），合并估计分数为103.25，95%置信区间：96.87 - 109.65（表明中度认知储备）。认知储备与中风后结果有不同的关联，三项研究（n = 7,759名参与者）报告与认知测量有显著负相关。脑衰弱通过影像学标志物进行评估。在四项研究（n = 3,086名参与者）中，脑衰弱的合并患病率为73.8%，95%置信区间：72.2 - 75.3。在大多数评估的研究中，较高的脑衰弱与较差的中风后结果相关。七项研究（50%）被评为低偏倚风险。
由于术语不一致和方法异质性，综合这些数据的尝试变得复杂。然而，我们的研究结果表明，脑衰弱在中风中很常见，并且与较差的结果相关。认知衰弱和储备的流行病学描述较少。所有这些指标可能对中风的预后评估有用，但在多个领域仍需要更多的研究。
