Epidemiology and Outcomes Associated with Cognitive Frailty and Reserve in a Stroke Population: Systematic Review and Meta-Analysis.

IF 2.2 3区 医学 Q3 CLINICAL NEUROLOGY Cerebrovascular Diseases Pub Date : 2024-09-30 DOI:10.1159/000541670
Lauren Binning, Catriona Basquill, Lucie Tvrda, Terry Quinn
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Abstract

Introduction: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

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中风人群中与认知虚弱和储备相关的流行病学和结果--系统回顾和荟萃分析。
背景:认知虚弱以及认知储备和基于成像的脑虚弱等相关概念在老年人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。我们旨在确定认知虚弱和认知储备在中风中的流行程度,并确定其对预后的影响:我们使用有效的检索语法在多学科电子数据库中进行了系统性综述。本综述的方案已经发布(PROSPERO,CRD42023433385)。我们确定了关于认知虚弱和认知储备的研究,包括使用相关概念的研究。我们通过提取数据来估算患病率以及与身体功能、认知能力和生活质量等结果之间的关系,并在可能的情况下进行荟萃分析。使用与研究设计相适应的纽卡斯尔-渥太华工具对偏倚风险进行了评估:我们搜索到了 12,095 项研究,其中 14 篇论文符合我们的标准。没有研究对认知虚弱进行了描述,只有研究对认知储备和大脑虚弱进行了描述。认知储备是通过教育、就业和业余时间等替代指标来评估的。四项研究使用了认知储备指数问卷(CRIq),汇总估计得分为 103.25,95%CI:96.87-109.65(表示中度认知储备)。认知储备与脑卒中后遗症的关系各不相同,其中有三项研究(人数=7759 人)报告了认知储备与认知指标的显著负相关。脑衰弱通过成像标记进行评估。四项研究(人数=3086 人)汇总的脑衰弱患病率为 73.8%,95%CI:72.2-75.3。在大多数评估研究中,脑衰弱程度越高,卒中后预后越差。七项研究(50%)的偏倚风险较低:由于术语的不一致和方法的异质性,试图综合这些数据的工作变得更加复杂。然而,我们的研究结果表明,脑衰弱在中风中很常见,并与较差的预后有关。关于认知功能衰弱和储备功能的流行病学描述较少。所有这些指标都可能对脑卒中的预后有用,但仍有多个领域需要更多的研究。
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来源期刊
Cerebrovascular Diseases
Cerebrovascular Diseases 医学-临床神经学
CiteScore
4.50
自引率
0.00%
发文量
90
审稿时长
1 months
期刊介绍: A rapidly-growing field, stroke and cerebrovascular research is unique in that it involves a variety of specialties such as neurology, internal medicine, surgery, radiology, epidemiology, cardiology, hematology, psychology and rehabilitation. ''Cerebrovascular Diseases'' is an international forum which meets the growing need for sophisticated, up-to-date scientific information on clinical data, diagnostic testing, and therapeutic issues, dealing with all aspects of stroke and cerebrovascular diseases. It contains original contributions, reviews of selected topics and clinical investigative studies, recent meeting reports and work-in-progress as well as discussions on controversial issues. All aspects related to clinical advances are considered, while purely experimental work appears if directly relevant to clinical issues.
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