The impact of frailty on cognitive outcomes in elderly patients with post-stroke subjective cognitive complaints

Frailty delineates a state of poor health characterized by the accumulation of age-related health deficits, and was associated with cognitive decline in patients with subjective cognitive complaints (SCC). However, whether cognitive recovery is related to frailty in elderly patients with post-stroke SCC remained unknown. This study investigated cognitive outcomes in patients with SCC within 1 year after stroke, identified the relationship between frailty and cognitive recovery, and determined factors associated with cognitive recovery.

Patients over the age of 60 with a clinical diagnosis of post-stroke SCC were included in this study, who had evidence of cognitive deficits, including Clinical Dementia Rating Scale (CDR) = 0.5, Montreal Cognitive Assessment (MoCA) score < 26, and Mini-Mental State Examination score > 17 (illiterate) or > 20 (primary school) or > 24 (junior school or above). A 32-item frailty index (FI) was operationalized using various data at baseline to measure frailty. Neuropsychological assessments were conducted at two time points: at baseline, which occurred within 2 weeks to 6 months of the stroke onset, and at the six-month follow-up. Cognitive recovery was operationalized as unimpaired cognition (MoCA score≥26 and CDR = 0) after 6 months. Factors associated with recovery were defined through logistic regression analysis.

After 6 months, 414 patients completed the follow-up with 53 (12.80%) presenting cognitive recovery. Contrary to expectations, frailty at baseline was not associated with cognitive recovery in patients with post-stroke SCC. A smaller proportion of women, higher baseline MoCA scores, and thalamus lesions were independently associated with high chance of cognitive recovery.

This study found no association between baseline frailty and cognitive recovery at 6 months in post-stroke SCC patients. However, sex, higher baseline MoCA scores, and thalamic lesions independently predict cognitive function recovery in patients with SCC after stroke, which may influence the effectiveness of intervention measures.