Cognitive Function and Longitudinal Changes in Cognition: Influencing Factors Among Rural Patients with Stroke in Nanhe County, China

Abstract

Background: Cognitive impairment is a significant public health issue among patients with stroke, particularly in rural China, where the prevalence of stroke is high, and healthcare resources are limited. Understanding the factors associated with cognitive function and its longitudinal changes is crucial for developing targeted interventions to mitigate cognitive decline in this vulnerable population.Objectives: This study aims to investigate cognitive function among rural patients with stroke in Nanhe County, China. Specifically, it investigates the associations between demographic, socioeconomic, and clinical factors with cognitive function at baseline and examines predictors of cognitive decline and improvement over time through longitudinal analysis. Methods: A mixed-method study design was employed, combining cross-sectional and longitudinal analyses. Data were derived from the System-Integrated Technology-Enabled Model of Care (SINEMA) trial, including 897 patients with stroke who completed the 2023 baseline assessment and the 2024 follow-up, approximately 1.5 years apart. Cognitive function was assessed using the Community Screening Instrument for Dementia (CSI-D), and functional independence was measured using the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scales. Descriptive analyses, chi-square tests, independent t-tests, one-way ANOVA, and multivariable regression models were applied to identify factors associated with cognitive function and its longitudinal changes. Results: At the 2023 baseline, the mean CSI-D score was 5.94 (SD = 2.27), remaining stable at 5.96 (SD = 2.47) in 2024. The proportion of participants with lower cognitive function (CSI-D 0–6) decreased from 57.19% to 51.73%, while those with higher cognitive function (CSI-D 7–9) increased from 42.81% to 48.27%. Cross-sectional analysis showed that older age, lower education, and depressive symptoms were significantly associated with lower cognitive function, whereas higher education and financial stability were linked to better cognitive outcomes. Longitudinally, non-poverty status and physical activity were associated with cognitive stability, while age ≥80 years increased the risk of cognitive decline (OR = 3.74, 95% CI: 1.06–13.2, p = 0.040). No variables were significantly associated with cognitive improvement. These findings highlight the importance of education, financial stability, and physical activity in preserving cognitive function among rural stroke survivors. Conclusions: This study highlights the associations between demographic, socioeconomic, and lifestyle factors with cognitive function among rural patients with stroke. Higher education and functional independence were linked to better cognitive function, whereas advanced age and financial hardship were associated with increased likelihood of cognitive deterioration. These findings underscore the need for targeted interventions, including educational programs, financial support mechanisms, and community-based rehabilitation services, to slow cognitive deterioration and improve the quality of life for rural patients with stroke.