Abstract
BACKGROUND: This systematic review aims to estimate the pooled prevalence of cognitive impairment among older adults Chinese stroke patients and to identify its demographic, clinical, and biochemical determinants, thereby providing evidence to support effective clinical prevention and intervention strategies. METHODS: Eight databases (CNKI, VIP, WanFang, CBM, PubMed, Web of Science, Embase, and the Cochrane Library) were systematically searched from inception to October 24, 2024. Studies were included if they enrolled Chinese older adults stroke patients (aged ≥60 years), analyzed risk factors for cognitive impairment using case-control/cohort designs, and adopted validated cognitive assessment tools such as the Mini-Mental State Examination [MMSE], Montreal Cognitive Assessment [MoCA]). Data extraction and quality assessment (using the Newcastle-Ottawa Scale) were independently performed by two reviewers. Meta-analysis was performed using Stata version 17.0. A random-effects model was applied for high heterogeneity (I(2) ≥ 50%), whereas a fixed-effects model was used otherwise. Publication bias was assessed using Egger's test and trim-and-fill method. RESULTS: A total of 46 studies, comprising 8,236 older adults stroke patients (3,281 with cognitive impairment) were included in the analysis. The pooled prevalence of cognitive impairment was 42.4% (95%CI: 36.6-48.3%), with significant heterogeneity (I(2) = 97.1%). Subgroup analyses showed higher prevalence in northern China (45.1%) compared with southern China (41.0%) and higher detection rates when using the MoCA (50.5%) than the MMSE (43.4%). The meta-analysis identified 13 robust risk factors, including female gender (OR = 4.167), hypertension (OR = 2.824), diabetes mellitus (OR = 3.344), frontal/temporal lobe infarction (OR = 1.615/1.739), multiple cerebral infarctions (OR = 2.583), brain atrophy (OR = 2.943), hyperhomocysteinemia (OR = 3.043), high-sensitivity C-reactive protein (Hs-CRP) (OR = 4.331), and National Institutes of Health Stroke Scale (NIHSS) scores (OR = 1.977) (all p < 0.05). Publication bias was detected in age-related analyses, and sensitivity analysis confirmed result stability except for CRP. CONCLUSION: Cognitive impairment affects 42.4% of older adults Chinese stroke patients and associated with modifiable risk factors (e.g., hypertension, diabetes) and anatomical correlates (e.g., frontal/temporal infarction). Future research should prioritize large-scale, prospective cohort studies to validate these findings and develop targeted interventions.