Cognitive Outcomes After Reperfusion Therapy for Acute Ischaemic Stroke: A Systematic Review and Meta-analysis and the PRECISE-ACTION Framework for Transdisciplinary Cognitive Management.
Samprithi Raja, Robert Weissert, Zeljka Calic, Pravin Thomas, Jasvinder Chawla, Susana Mederer Hengstl, Ivica Smokovski, Olga Golubnitschaja, Tomotaka Tanaka, Kevin J Spring, Murray C Killingsworth, Man Mohan Mehndiratta, Rajesh N Kalaria, Masafumi Ihara, Sonu M M Bhaskar
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Abstract
Background: Post-stroke cognitive impairment (PSCI) is disabling after acute ischaemic stroke (AIS), but cognitive outcomes after reperfusion therapy remain uncertain because studies differ in treatment pathways, cognitive tools, follow-up timing, and ascertainment.
Objectives: To estimate PSCI prevalence after AIS reperfusion therapy and evaluate comparative cognitive, safety, and functional outcomes.
Methods: This systematic review and meta-analysis searched PubMed/MEDLINE, Embase, and CENTRAL from 1 January 2000 to 31 May 2024, with an updated search on 16 June 2026. Random-effects models were used. Risk ratios (RRs) were the primary comparative binary measure; odds ratios (ORs) were sensitivity analyses.
Results: Twenty-eight distinct study records comprising 18,322 participants were included in this meta-analysis. Pooled PSCI prevalence was 33% in treatment-arm analyses (95% CI 14-54%; I2 = 99.48%) and 39% in overall or single-arm cohorts (95% CI 24-56%; I2 = 99.60%). Extreme between-study heterogeneity (I2 ≈ 99%) limited the precision and generalisability of the pooled prevalence estimates. Reperfusion therapy was not associated with PSCI risk (RR 1.10, 95% CI 0.94-1.29; p = 0.241); OR sensitivity analysis was consistent (OR 1.26, 95% CI 0.91-1.75; p = 0.169). Continuous cognitive outcomes showed a pooled standardised mean difference of 0.67 (95% CI 0.16-1.18; p = 0.010), with substantial heterogeneity.
Conclusions: Post-stroke cognitive impairment remains frequent after AIS reperfusion therapy, affecting approximately one-third of reperfusion-treated patients and two-fifths of overall or single-arm cohorts. Comparative RR and OR analyses did not show a robust overall association between reperfusion exposure and PSCI risk, while cognitive score differences were significant but heterogeneous. These findings support routine cognitive assessment, harmonised endpoints, and prospective therapy-specific follow-up. PRECISE-ACTION is proposed as a preliminary, hypothesis-generating transdisciplinary framework for structured cognitive assessment, longitudinal tracking, integrated care, and future research.
Registration: Open Science Framework (OSF), 2nbeh.
背景：脑卒中后认知障碍（PSCI）是急性缺血性卒中（AIS）后的致残，但再灌注治疗后的认知结果仍不确定，因为研究在治疗途径、认知工具、随访时间和确定方面存在差异。目的：评估AIS再灌注治疗后PSCI的患病率，并评估认知、安全性和功能方面的比较结果。方法：本系统综述和荟萃分析检索了PubMed/MEDLINE、Embase和CENTRAL，检索时间为2000年1月1日至2024年5月31日，更新检索时间为2026年6月16日。采用随机效应模型。风险比（rr）是主要的比较二元指标；优势比（ORs）为敏感性分析。结果：28个不同的研究记录包括18,322名参与者纳入本荟萃分析。在治疗组分析中，PSCI合并患病率为33% (95% CI 14-54%; I2 = 99.48%)，在整体或单组队列中为39% （95% CI 24-56%; I2 = 99.60%）。研究间的极端异质性（I2≈99%）限制了汇总患病率估计的准确性和普遍性。再灌注治疗与PSCI风险无关（RR 1.10, 95% CI 0.94-1.29; p = 0.241）；OR敏感性分析结果一致（OR 1.26, 95% CI 0.91-1.75; p = 0.169）。连续认知结果显示合并标准化平均差异为0.67 (95% CI 0.16-1.18; p = 0.010)，存在显著异质性。结论：脑卒中后认知障碍在AIS再灌注治疗后仍然很常见，影响了大约三分之一的再灌注治疗患者和五分之二的整体或单臂队列。比较RR和OR分析没有显示再灌注暴露与PSCI风险之间的强大整体关联，而认知评分差异显着但异质性。这些发现支持常规认知评估、统一终点和前瞻性治疗特异性随访。precision - action被提议作为一个初步的、产生假设的跨学科框架，用于结构化认知评估、纵向跟踪、综合护理和未来的研究。注册：开放科学框架（OSF）， 2月。
期刊介绍：
Clinical Drug Investigation provides rapid publication of original research covering all phases of clinical drug development and therapeutic use of drugs. The Journal includes:
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