TY - JOUR
T1 - Cognitive Recovery After Stroke
T2 - A Meta-analysis and Metaregression of Intervention and Cohort Studies
AU - Saa, Juan Pablo
AU - Tse, Tamara
AU - Baum, Carolyn M.
AU - Cumming, Toby
AU - Josman, Naomi
AU - Rose, Miranda
AU - O’Keefe, Sophie
AU - Sewell, Katherine
AU - Nguyen, Vinh
AU - Carey, Leeanne M.
N1 - Publisher Copyright:
© The Author(s) 2021.
PY - 2021/7
Y1 - 2021/7
N2 - 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 (τ
2 = 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.
AB - 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 (τ
2 = 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.
KW - Clinical Studies as Topic
KW - Cognitive Dysfunction/etiology
KW - Cohort Studies
KW - Executive Function
KW - Humans
KW - Outcome and Process Assessment, Health Care
KW - Stroke Rehabilitation
KW - Stroke/complications
UR - http://www.scopus.com/inward/record.url?scp=85106453334&partnerID=8YFLogxK
U2 - 10.1177/15459683211017501
DO - 10.1177/15459683211017501
M3 - Review article
C2 - 34027728
AN - SCOPUS:85106453334
SN - 1545-9683
VL - 35
SP - 585
EP - 600
JO - Neurorehabilitation and Neural Repair
JF - Neurorehabilitation and Neural Repair
IS - 7
ER -
