ORIGINAL RESEARCH article
Front. Aging Neurosci.
Sec. Neurocognitive Aging and Behavior
This article is part of the Research TopicAdvancing Cognitive Reserve Assessment: Multidisciplinary Approaches and MethodologiesView all articles
Is Cognitive Reserve Associated with Cognitive Function Across Stroke Severity? A Longitudinal Study Among Chinese Stroke Patients
Provisionally accepted
- 1Huashan Hospital, Fudan University, Shanghai, China
- 2Shanghai Fourth People's Hospital, Shanghai, China
- 3Air Force Hospital of Eastern Theater Command, Nanjing, China
- 4Duke University School of Nursing, Durham, United States
- 5New York University Rory Meyers College of Nursing, New York, United States
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Background：Cognitive decline is common after stroke. This study assessed the longitudinal associations between cognitive reserve and post-stroke cognitive function and tested whether these associations differ across patients’ stroke severity. Methods：A longitudinal survey was conducted among 371 patients with acute ischemic stroke from four stroke centers in China from 2022-2023. Eligible patients were recruited at acute stage and followed up at 3 and 6 months after onset. Cognitive reserve was assessed by Cognitive Reserve Index questionnaire within 7 days after stroke onset. Cognitive function was assessed by Montreal Cognitive Assessment, Changsha Version at each time point. Stroke severity was assessed using the National Institutes of Health Stroke Scale at admission. Linear mixed models were applied to assess associations between cognitive reserve and cognitive function across stroke severity. Results: Among stroke survivors, cognitive function improved over time after the onset (βtime=0.40, p＜0.001). Higher level of cognitive reserve was associated with better cognitive function (βcognitive reserve=0.08, p＜0.001) after controlling for covariates. These associations remained over time (βcognitive reservetime=0.01, p=0.009) and did not differ across patients with different stroke severity (βcognitive reservestroke severity=0.01, p=0.11). Conclusions: Cognitive reserve can potentially mitigate the impact of stroke on long-term cognitive decline in Chinese patients with acute ischemic stroke. Targeting cognitive reserve may be a viable strategy to prevent or slow post-stroke cognitive decline. The study supports a more nuanced assessment of cognitive reserve as a standard in clinical studies.
Keywords: Cognitive Reserve, Post stroke cognitive impairment, stroke severity, Acute ischemic stroke, longitudinal study
Received: 23 Jun 2025; Accepted: 03 Nov 2025.
Copyright: © 2025 Ou, Zhang, Lv, Ding, Kong, Xu, Wu, Wei and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Yinuo Ou, ouyinuo2019@outlook.com
Hui Wei, qine0829@163.com
Juan Li, lijuanjr@126.com
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