Chain mediation analysis of fall risk and independent living skills in patients with acute ischemic stroke between cognitive dysfunction and frailty.

A substantial body of literature indicates that cognitive dysfunction adversely affects activities of daily living in patients with acute ischemic stroke (AIS) and is associated with an accelerated onset of frailty. This study aims to verify the association between cognitive dysfunction and frailty in patients with AIS and to explore the serial mediating role of fall risk and independent living skills in this relationship. Participants were consecutively enrolled from August 2023 to December 2024 among hospitalized patients diagnosed with AIS in the neurology department of a tertiary care hospital, using convenience sampling. Data were collected using standardized assessment instruments, including the General Information Questionnaire, the Montreal Cognitive Assessment-Basic Scale, the Morse Fall Scale, the Barthel Index Scale, and the Edmonton Frail Scale. Mediation analyses were conducted using IBM SPSS 29.0 and the PROCESS macro (version 4.1, Model 6). Cognitive dysfunction exhibited significant negative correlations with fall risk (r = -0.249, P < .001) and frailty (r = -0.376, P < .001) and a significant positive correlation with independent living skills (r = 0.315, P < .001). Fall risk was significantly positively correlated with frailty (r = 0.391, P < .001) and significantly negatively correlated with independent living skills (r = -0.448, P < .001). Independent living skills were also significantly negatively correlated with frailty (r = -0.478, P < .001). Mediation analysis revealed that cognitive dysfunction had a direct effect on frailty (-0.032), accounting for 61.54% of the total effect (-0.052); fall risk and independent living skills exerted a partial mediating role in this relationship, with a total indirect effect of -0.020, contributing to 38.46% of the total effect. The association between cognitive dysfunction and frailty in patients with AIS is mediated by fall risk and independent living skills. Clinically, interventions targeting cognitive dysfunction may reduce fall risk and improve independent living skills, thereby mitigating frailty symptoms.