Background

Cognition affects poststroke recovery, but meta-analyses of cognition have not yet provided a comparison of observational and intervention evidence.

Objective

To describe the trajectory of poststroke cognition and the factors that moderate it across intervention and observational cohorts.

Methods

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.

Results

A total of 43 intervention trials and 79 observation cohorts involving 28 222 stroke participants were included. Heterogeneity was significant (τ² = 0.09; CI = 0.01-0.21, P < .001) with no evidence of publication bias. Cognitive recovery was greater in intervention trials (g = 0.47; CI = 0.37-0.58) than observational cohorts (g = 0.28; CI = 0.20-0.36) across all moderators analyzed. Nonroutine/alternative and pharmacological trials achieved the best overall results (g = 0.57, CI = 0.42-0.73, and g = 0.52, CI = 0.30-0.74, respectively), followed by therapist-led (g = 0.46; CI = 0.17-0.74), and usual care (g = 0.28; CI = 0.11-0.45) interventions. Medium recovery effects (ie, g ≥ 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.

Conclusion

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.

中文翻译：

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中风后的认知恢复：干预和队列研究的元分析和元回归

背景

认知影响中风后的恢复，但认知的荟萃分析尚未提供观察和干预证据的比较。

客观的

描述中风后认知的轨迹以及在干预和观察队列中调节它的因素。

方法

搜索了截至 2020 年 1 月的六个数据库。包括描述成人卒中后认知定量变化的研究。干预措施分为药理学、治疗师主导、非常规/替代和常规护理。通过分层混合效应模型比较汇总估计。年龄、恢复阶段、中风病因、研究中针对的认知领域和干预类型作为认知调节因素进行了调查。在乘法元回归模型中进一步分析恢复阶段和干预。

结果

共纳入 43 项干预试验和 79 个观察队列，涉及 28 222 名卒中参与者。异质性显着（τ ² = 0.09；CI = 0.01-0.21，P < .001），没有发表偏倚的证据。在所分析的所有调节者中，干预试验 ( g = 0.47；CI = 0.37-0.58) 的认知恢复程度高于观察性队列 ( g = 0.28；CI = 0.20-0.36)。非常规/替代和药理学试验取得了最好的总体结果（g = 0.57，CI = 0.42-0.73，g = 0.52，CI = 0.30-0.74），其次是治疗师主导的（g = 0.46；CI = 0.17- 0.74）和日常护理（g= 0.28; CI = 0.11-0.45) 干预措施。在 65 至 70 岁的参与者中，在中风后 61 至 180 天检查首次中风、执行功能、视觉感知、意识和精神运动技能时，观察到中等恢复效果（即g ≥ 0.5）。

结论

在所有恢复阶段使用不同的受控干预措施可以实现认知恢复，但在卒中后 2 年以上获益较小。需要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活动表现之间的关联。