Abstract
Cognitive impairment frequently occurs following stroke, yet its underlying risk factors remain insufficiently elucidated. This study explored how pre-stroke disability, related factors, and post-stroke cognitive results are connected in elderly Chinese individuals. This study analyzed China Health and Retirement Longitudinal Study (CHARLS) data from 2015 to 2018 to evaluate activities of daily living (ADL) and instrumental activities of daily living (IADL) disabilities using standardized scales. Binary logistic regression analyzed the potential link between pre-stroke ADL disability and subsequent post-stroke cognitive impairment. Subgroup analyses were stratified by age, gender, residence, and education, with sensitivity analyses conducted to test result robustness. Out of 404 participants, 18.1% experienced cognitive decline following a stroke. The logistic regression analysis identified a strong link between functional limitations in ADL or IADL before the stroke and subsequent cognitive impairment (P < 0.001). Those with impaired ADL function had an elevated risk (OR = 2.20; 95% CI: 1.27–3.75), and a similar pattern was observed for IADL limitations (OR = 3.31; 95% CI: 1.94–5.65). These findings were further supported by sensitivity analyses conducted with linear regression models, reinforcing the reliability of the observed associations. This research verified that limitations in ADL and IADL prior to stroke were significantly linked to cognitive decline following stroke. Among older stroke patients in China, both ADL and IADL impairments emerged as relevant predictors of post-stroke cognitive impairment. Evaluating functional status in adults aged 45 and above may aid in the early detection of those at elevated risk for future cognitive deterioration.
Data availability
Further information regarding the CHARLS dataset can be accessed at the following link: http://charls.pku.edu.cn/pages/data/111/zhcn.html.The datasets supporting the findings of this study can be obtained from the corresponding author upon reasonable request.
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Acknowledgements
Acknowledgments The authors sincerely thank the team of the China Health and Retirement Longitudinal Study (CHARLS) for their valuable support in data collection, organization, and granting access to the dataset. We also appreciate the contributions of all study participants, whose cooperation made this research possible.
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X.H. wrote the main manuscript text, Z.M made significant contributions to the revision process and T.X. reviewed and proofread the manuscript. All authors approved the final version of the manuscript.
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The human studies received approval from the Institutional Review Board of Peking University (IRB00001052-11015). All procedures were conducted in compliance with applicable laws and institutional guidelines. In accordance with national regulations and institutional policies, written informed consent from participants or their legal representatives/next of kin was not required.
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Huang, X., Tang, Z. & Xiong, T. Associations of pre-stroke function disability and post-stroke cognitive impairment among older adults in China. Sci Rep (2026). https://doi.org/10.1038/s41598-026-39018-0
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DOI: https://doi.org/10.1038/s41598-026-39018-0
