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Updated: Oct 7, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Cognitive Outcomes After Reperfusion Therapy for Acute Ischaemic Stroke: A Systematic Review and Meta-analysis and
Samprithi Raja1,2,3, Robert Weissert4, Zeljka Calic1,2,3,5
1Global Health Neurology Lab, Sydney, NSW, Australia.
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.
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