Study on the trajectory and influencing factors of post-stroke cognitive development: based on a group-based trajectory model

BACKGROUND: Post-stroke cognitive impairment (PSCI) is one of the major complications of stroke and exhibits a dynamic progression. This study uses the Group-Based Trajectory Model (GBTM) to fit cognitive development trajectories in stroke patients and analyze the influencing factors and trends of PSCI across trajectory groups. It aims to facilitate early identification and intervention for high-risk PSCI patients, providing a theoretical basis for optimizing intervention strategies. METHODS: The study employs a longitudinal design and completed the follow-up of 729 patients across five hospitals. The MoCA scale is used to assess the cognitive function of stroke patients at baseline, 1 month, 3 months, and 6 months. GBTM is employed to fit the cognitive development trajectories of PSCI, and multinomial logistic regression is used to analyze its influencing factors. RESULTS: The GBTM results show that there are four post-stroke cognitive development trajectories in stroke patients, namely, severe PSCI group, mild PSCI group, PSCI risk group and normal cognitive group. Advanced age, high NIHSS score, living alone, fatigue, malnutrition, and risk of malnutrition are risk factors for PSCI. High ADL scores, higher education levels, living in urban areas, urban workers medical insurance, and high average monthly family income are protective factors for PSCI (P<0.05). CONCLUSIONS: Post-stroke cognitive development trajectories exhibit heterogeneity. In clinical practice, it is recommended that healthcare professionals pay attention to early screening, early diagnosis, early intervention, and early treatment of PSCI, to improve or delay the development of PSCI by preventing or treating the primary disease.