Determinants of Post-Stroke Cognitive Impairment After Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Acute ischemic stroke (AIS) is frequently complicated by post-stroke cognitive impairment (PSCI), which significantly affects long-term prognosis and quality of life. However, the evidence regarding its risk factors remains inconsistent.

A systematic search was conducted in PubMed, Embase, Cochrane Library, and Web of Science up to December 30, 2025. Observational studies evaluating risk factors for PSCI after AIS were included. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using fixed- or random-effects models. Heterogeneity, sensitivity analyses, and publication bias were assessed.

Fifteen studies involving 30,022 participants were included. Age >75 years (OR = 1.07, 95% CI: 1.04-1.10), female sex (OR = 1.72, 95% CI: 1.41-2.10), diabetes (OR = 1.76, 95% CI: 1.29-2.40), elevated C-reactive protein (CRP; OR = 1.36, 95% CI: 1.14-1.62), and lower educational level (OR = 1.24, 95% CI: 1.12-1.38) were significantly associated with an increased risk of PSCI after AIS. Substantial heterogeneity was observed for some predictors, particularly age (I² = 89.9%) and educational level (I² = 89.6%).

Several factors, including advanced age, female sex, diabetes, elevated CRP, and lower educational level, were associated with an increased risk of PSCI after AIS. These findings may support risk stratification and early monitoring strategies. However, the substantial heterogeneity observed for some predictors should be considered when interpreting the pooled estimates. Further prospective studies are needed to confirm these associations and clarify causal relationships.