Differences in dietary recall and subjective physical functioning status in stroke survivors with self-reported cognitive impairment

Associations between diet and cognitive function in stroke survivors: A systematic review and meta-analysis

Post-stroke cognitive decline is a major form of disability in stroke survivors. While dietary interventions have shown potential in improving cognitive outcomes in stroke-free populations, their effects on stroke survivors remain unclear. This review aimed to evaluate associations between diet and cognitive function in stroke survivors. MEDLINE, Embase, Scopus, and CINHAL were searched for studies from inception to 16 December 2024. Eligible articles were observational and interventional studies on adult stroke survivors that evaluated the association/effect of any nutritional exposure/intervention on cognitive performance and dementia risk. Studies were excluded when an intervention was combined with non-nutritional treatment. Random-effects meta-analysis was used for similar randomised clinical trials. This review included 20 clinical trials and 14 observational studies assessing the intake of energy and proteins, a variety of single nutrients, as well as dietary patterns, single foods and phytochemicals. Meta-analyses revealed a positive effect of energy-protein supplementation on global cognition (standardised mean difference (SMD): 0.62, 95% confidence interval (CI): 0.15, 1.08, p = 0.009), and a negative effect of B-vitamins (folic acid, B6 and B12) (SMD: -0.40, 95% CI: -0.72, -0.08, p = 0.02). Adherence to the Mediterranean-DASH intervention for neurodegenerative delay (MIND) and plant-based diets, as well as higher consumption of fruits, milk, coffee, vitamin E, and selenium, were related to better cognitive outcomes; no significant association was observed for adherence to the dietary approaches to stop hypertension (DASH) and Mediterranean diets and consumption of vitamins D and C. Butter and sugar intake, and calcium supplementation were associated with negative cognitive outcomes. Mixed results were seen for omega-3, tea and plant extracts. The available evidence indicates that energy-protein supplementation may benefit cognition after stroke, while B-vitamin supplementation has no effect. The substantial heterogeneity among studies hinders conclusions about other dietary strategies. This review was registered with PROSPERO (no. CRD42024541785). STATEMENT OF SIGNIFICANCE: This systematic review provides insights into the relationship between diet and post-stroke cognitive outcomes, indicating that energy-protein supplementation can enhance the cognitive function of stroke survivors, whereas B-vitamin supplements may negatively impact cognitive outcomes.

Subjective and objective assessments are associated for physical function but not cognitive function in community-dwelling stroke survivors

PURPOSE

To investigate the relation between subjectively and objectively assessed cognitive and physical functioning among community-dwelling stroke survivors, and to examine the association of stroke severity with subjectively and objectively assessed cognitive and physical impairments.

MATERIALS AND METHODS

Secondary data analysis was conducted with 127 community-dwelling stroke survivors. For cognitive functioning, objective measures included the NIH Toolbox Cognition Battery and the Executive Function Performance Test; subjective measures included the Quality of Life in Neurological Disorders Applied Cognition. Objective and subjective physical functioning was measured by the NIH Toolbox 2-Minute Walk Test and the Patient-Reported Outcomes Measurement Information System Physical Function, respectively.

RESULTS

A positive correlation was observed between subjective and objective physical functioning, whereas the correlation between subjective and objective cognitive functioning was nonsignificant. Stroke severity was associated with objective cognitive impairment and objective and subjective physical impairment, but not subjective cognitive impairment.

CONCLUSIONS

The lack of association between objective and subjective cognitive functioning challenges the conventional assumption that perceived functioning reflects actual performance. We recommend using both objective and subjective measures to accurately identify cognitive and physical impairment following stroke.Implications for RehabilitationSubjective cognitive functioning is not associated with objective cognitive functioning, suggesting that solely relying on stroke patients' reports is inadequate and may inaccurately estimate patients' actual deficits.Both objective and subjective measures should be used to accurately identify cognitive and physical impairment following stroke.Practitioners should be cognizant of stroke patients' behavioral signs associated with underlying cognitive problems that warrant further evaluation.

Effect of Early Cognitive Training Combined with Aerobic Exercise on Quality of Life and Cognitive Function Recovery of Patients with Poststroke Cognitive Impairment

Objective

To explore the effect of early cognitive training combined with aerobic exercise on quality of life (QOL) and cognitive function recovery of patients with poststroke cognitive impairment (PSCI).

Methods

Ninety PSCI patients treated in our hospital from April 2019 to April 2020 were selected as the subjects and were divided into the experimental group (EG) and control group (CG) according to the admission order, with 45 cases each. Patients in CG received conventional health education combined with rehabilitation training, and those in EG accepted early cognitive training combined with aerobic exercise so as to evaluate the clinical effect of different intervention modes on PSCI patients.

Results

Compared with CG after intervention, EG obtained an obviously higher Stroke Specific Quality of Life scale (SS-QOL) score, Montreal Cognitive Assessment (MoCA) score, Barthel Index (MBI) (BI) score and Functional Independence Measure (FIM) score (P < 0.001), and obviously shorter time for completing TMT-A and TMT-B (P < 0.001).

Conclusion

Performing early cognitive training combined with aerobic exercise for PSCI patients can effectively improve their QOL and promote the recovery of cognitive function. Compared with conventional health education combined with rehabilitation training, this mode presents a higher application value. Further study will be conducive to establishing a better solution for patients.