Archives of physical medicine and rehabilitation · 2026
Association of Combined Physical and Cognitive Rehabilitation With Poststroke Dementia: A US Multicenter Retrospective Cohort Study.
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Hung Yu-Chien, Hung Chun-Tse, An Chen-Yen, Lin Wen-Chih, Hung Shun-Hsing, Wu Chung-Hsuen
Аннотация
OBJECTIVE: To compare the effectiveness of combined physical rehabilitation (PR) and cognitive rehabilitation (CR) versus PR alone in reducing the risk of developing poststroke dementia.
DESIGN: Retrospective cohort study.
SETTING: US TriNetX Collaborative Network, a multicenter federated electronic health record database.
PARTICIPANTS: Adults aged ≥55 years (N=130,538) diagnosed with stroke between January 1, 2010, and December 31, 2020, who developed mild cognitive impairment (MCI) within 6 months after stroke. Patients were classified according to receipt of combined PR and CR or PR alone within six months after stroke. After 1:1 propensity score matching, 479 patients were included in each group.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Incident poststroke dementia occurring ≥6 months after index stroke.
RESULTS: Compared with the PR-only group, the combined PR and CR group had a lower risk of poststroke dementia (hazard ratio, 0.58; 95% CI, 0.40-0.84). The association remained consistent across sensitivity analyses. Subgroup analyses showed similar associations among men and patients without intensive care unit stay during the index stroke hospitalization.
CONCLUSIONS: Among older adults with poststroke MCI, combined PR and CR was associated with a lower risk of incident poststroke dementia compared with PR alone. These findings support the potential role of combined rehabilitation strategies in preserving long-term cognitive health after stroke.
DESIGN: Retrospective cohort study.
SETTING: US TriNetX Collaborative Network, a multicenter federated electronic health record database.
PARTICIPANTS: Adults aged ≥55 years (N=130,538) diagnosed with stroke between January 1, 2010, and December 31, 2020, who developed mild cognitive impairment (MCI) within 6 months after stroke. Patients were classified according to receipt of combined PR and CR or PR alone within six months after stroke. After 1:1 propensity score matching, 479 patients were included in each group.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Incident poststroke dementia occurring ≥6 months after index stroke.
RESULTS: Compared with the PR-only group, the combined PR and CR group had a lower risk of poststroke dementia (hazard ratio, 0.58; 95% CI, 0.40-0.84). The association remained consistent across sensitivity analyses. Subgroup analyses showed similar associations among men and patients without intensive care unit stay during the index stroke hospitalization.
CONCLUSIONS: Among older adults with poststroke MCI, combined PR and CR was associated with a lower risk of incident poststroke dementia compared with PR alone. These findings support the potential role of combined rehabilitation strategies in preserving long-term cognitive health after stroke.