Clinical drug investigation · 2026
Cognitive Outcomes After Reperfusion Therapy for Acute Ischaemic Stroke: A Systematic Review and Meta-analysis and the PRECISE-ACTION Framework for Transdisciplinary Cognitive Management.
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Raja Samprithi, Weissert Robert, Calic Zeljka, Thomas Pravin, Chawla Jasvinder, Hengstl Susana Mederer, Smokovski Ivica, Golubnitschaja Olga, Tanaka Tomotaka, Spring Kevin J, Killingsworth Murray C, Mehndiratta Man Mohan, Kalaria Rajesh N, Ihara Masafumi, Bhaskar Sonu M M
Аннотация
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.
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.