Frontiers in Neurology · Jul 8, 2026

Prevalence of cognitive frailty in older adults with stroke in China: a systematic review and meta-analysis

By Li Y, Zhang Z, Cai Y et al.

OBJECTIVE: Stroke is a leading cause of disability and mortality in older adults. Post-stroke cognitive frailty (CF) increases the risk of adverse outcomes. However, evidence regarding the prevalence of CF remains limited and inconsistent. This study aims to systematically evaluate the prevalence of CF among older adults with stroke in China and identifies factors associated with variation in prevalence, thereby informing future research directions and potential clinical considerations. METHODS: We searched PubMed, Embase, Web of Science, Cochrane Library, China Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), VIP Database, and Wanfang Database for relevant studies reporting the prevalence of CF in Chinese older adults with stroke. The search covered the period from each database's inception to November 2024. Eligible studies were assessed for quality, and data were extracted. All analyses were performed using Stata 18.0 software. RESULTS: Four Chinese studies involving 1,337 participants were included. Meta-analysis revealed a pooled prevalence of CF among older adults with stroke of 33% (95% CI: 28-39%). Subgroup analysis indicated a significantly higher prevalence of CF in stroke patients aged ≥80 years compared to those aged 60-79 years (p < 0.05). Furthermore, the prevalence was significantly higher among those who consumed alcohol than among non-consumers (p < 0.05). Notably, subgroup estimates for patients with malnutrition and depression were markedly high, at 47% (95% CI: 34-60%) and 62% (95% CI: 53-71%), respectively. CONCLUSION: Available evidence suggests that the prevalence of CF among older adults with stroke in China appears to be substantial, with significant variations associated with alcohol consumption and advanced age. The particularly high prevalence estimates in patients with malnutrition or depression warrant increased clinical attention and further investigation into their relationship with post-stroke CF. Caution is warranted given the limited evidence base (n = 4), high heterogeneity, and exclusively hospital-based Chinese setting; larger studies are needed to confirm these observations. Early identification and evidence-based interventions targeting CF in this population may be crucial to mitigating adverse health outcomes pending further validation. SYSTEMATIC REVIEW REGISTRATION: This systematic review was prospectively registered with PROSPERO (registration number: CRD42025643159).

doi.org/10.3389/fneur.2026.1742673Open accessPubMed 42488386Populations