SYSTEMATIC REVIEW article
Front. Public Health
Sec. Aging and Public Health
Prevalence and Determinants of Cognitive Impairment in Elderly Stroke Patients in China: A Systematic Review
Provisionally accepted
- Affiliated Hospital of North Sichuan Medical College, Nanchong, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: This systematic review aims to estimate the pooled prevalence of cognitive impairment in elderly Chinese stroke patients and identify its demographic, clinical, and biochemical determinants, providing evidence for clinical prevention and intervention strategies. Methods: Eight databases (CNKI, VIP, WanFang, CBM, PubMed, Web of Science, Embase, Cochrane Library) were searched from inception to October 24, 2024. Studies were included if they involved Chinese elderly (≥60 years) stroke patients, analyzed risk factors for cognitive impairment using case-control/cohort designs, and adopted validated cognitive assessment tools (e.g., Mini-Mental State Examination [MMSE], Montreal Cognitive Assessment [MoCA]). Data extraction and quality assessment (Newcastle-Ottawa Scale) were performed by two reviewers. Meta-analysis was conducted using Stata 17.0, with random-effects models for high heterogeneity (I² ≥50%) and fixed-effects models otherwise. Publication bias was evaluated via Egger's test and trim-and-fill methods. Results: A total of 46 studies (8,236 cases, 3,281 with cognitive impairment) were included. The pooled prevalence of cognitive impairment was 42.4% (95%CI: 36.6%–48.3%), with significant heterogeneity (I²=97.1%). Subgroup analysis showed higher prevalence in northern China (45.1%) than southern China (41.0%) and higher detection rates using MoCA (50.5%) versus MMSE (43.4%). Meta-analysis identified 13 robust risk factors, including female gender (OR=4.167), hypertension (OR=2.824), diabetes mellitus (OR=3.344), frontal/temporal lobe infarction (OR=1.615/1.739), multiple cerebral infarctions (OR=2.583), brain atrophy (OR=2.943), hyperhomocysteinemia (OR=3.043), high-sensitivity C-reactive protein (Hs-CRP) (OR=4.331), and National Institutes of Health Stroke Scale (NIHSS) score (OR=1.977) (all P < 0.05). Publication bias was observed in age-related analyses, and sensitivity analysis confirmed result stability except for CRP. Conclusion: Cognitive impairment affects 42.4% of elderly Chinese stroke patients, with modifiable risk factors (e.g., hypertension, diabetes) and anatomical correlates (e.g., frontal/temporal infarction). Future research should prioritize large-scale, prospective cohort studies to validate findings and develop targeted interventions.
Keywords: Stroke, cognitive impairment, Elderly, Prevalence, Risk factors, Meta-analysis
Received: 16 Sep 2025; Accepted: 10 Nov 2025.
Copyright: © 2025 Lan, Chen and Lei. 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: Yang Lan, yanglanglanyang@163.com
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.