Prevalence Trends and Influencing Factors for Post-stroke Cognitive Impairment in China：a Meta-analysis postprint

Abstract: Background  Post-stroke cognitive impairment（PSCI） is a common sequela of stroke that severely impacts patients' quality of life and is often overlooked. The high incidence，subtle symptoms，and substantial social burden of PSCI make it a research priority. Understanding the prevalence and associated factors of PSCI is crucial for improving stroke prevention and treatment strategies. Objective  To systematically evaluate the prevalence and trends of PSCI in China from 2014 to 2024 and summarize the related risk and protective factors. Methods  Relevant studies on the prevalence and influencing factors of PSCI in China were retrieved from databases including PubMed，Web of Science，Embase，and CNKI，covering the period from November 2014 to November 2024. Stata 16.0 and SPSS 26.0 software were used to analyze the current status and trends of PSCI，and RevMan 5.4 software was employed to analyze related factor. Results  A total of 59 studies were included in this analysis，revealing that the overall prevalence of PSCI in China was 51%（95%CI=48%-55%）. The prevalence of PSCI among males and females was 50%（95%CI=46%-54%） and 56%（95%CI=51%-60%），respectively. Patients aged under 60 years and those aged 60 years and above exhibited prevalence rates of 47%（95%CI=40%-55%） and 59%（95%CI=50%-67%），respectively. The prevalence in East China，South China，North China，Central China，Northeast China，Northwest China and Southwest China was 49%（95%CI=42%-56%），48%（95%CI=36%-61%），53%（95%CI=44%-62%）， 48%（95%CI=40%-56%），57%（95%CI=54%-60%），42%（95%CI=32%-52%）and 51%（95%CI=43%-59%）， respectively. Furthermore，the prevalence of hemorrhagic and ischemic stroke was 54%（95%CI=41%-67%）and 52%（95%CI=48%-56%），respectively. At different time points（≤ 2 weeks，2 weeks~3 months，3~6 months，>6 months），the prevalence rates were 52%（95%CI=45%-58%），52%（95%CI=45%-58%），40%（95%CI=35%-44%） and 56%（95%CI=43%-70%） respectively. The highest prevalence rate of 63%（95%CI=55%-71%） was observed in individuals with lower education levels（primary school and below）. Additionally，the prevalence among married and unmarried individuals was 57%（95%CI=46%-68%） and 64%（95%CI=52%-75%），respectively. The prevalence among employed and unemployed individuals was 64%（95%CI=44%-84%） and 71%（95%CI=56%-87%），respectively. Finally，the prevalence among mental workers and manual workers was 48%（95%CI=33%-64%） and 53%（95%CI=30%-76%），respectively，while those living with family members and living alone exhibited prevalence rates of 62%（95%CI=43%-82%） and 71%（95%CI=62%-81%），respectively. The prevalence of PSCI in China increased with age（χ2 =73.805，P<0.01），and was notably higher among individuals with lower education levels（χ2 trend=164.711，P<0.01）. There were significant differences among different regions（χ2 =74.701，P<0.01）. With the extension of assessment periods，the prevalence showed an upward trend（χ2 trend=186.504，P<0.05）. Although a significant difference in prevalence rates was observed across different periods（χ2 trend=325.964，P<0.01），no linear correlation was identified（P=0.259）. Factors such as age，female gender，hypertension，diabetes，hyperlipidemia，a history of stroke，carotid plaque，hyperhomocysteinemia，C-reactive protein levels，smoking，drinking and NIHSS score were identified as risk factors for PSCI in China，whereas education level and physical exercise emerged as protective factors. Conclusion  The overall prevalence of PSCI in China is notably high，exhibiting significant regional and provincial variations，as well as a dynamic trend over time. The prevalence is particularly elevated among females，the elderly，and individuals with lower educational attainment. Additionally，hypertension，diabetes，and hyperlipidemia are identified as risk factors for PSCI. It is imperative for medical institutions at all levels to prioritize these high-risk groups，and expedite the development and implementation of comprehensive prevention and control strategies for PSCI to alleviate the social care burden and economic strain in China.