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 - Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: James S. McDonnell Foundation (Cognitive Rehabilitation Collaborative Award 220020413), Commonwealth Science and Industrial Research Organisation (CSIRO) flagship collaborative fund, National Health and Medical Research Council of Australia (NHMRC, Awards 1077898, 1153236, 1113352 and 2004443), and a La Trobe University Postgraduate Research Grant (LTUPRS).
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 (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.
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 (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.
KW - cognition
KW - executive function
KW - longitudinal studies
KW - meta-analysis
KW - rehabilitation
KW - stroke
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
VL - 35
SP - 585
EP - 600
JO - Neurorehabilitation and Neural Repair
JF - Neurorehabilitation and Neural Repair
SN - 1545-9683
IS - 7
ER -