Observational studyEuropean stroke journal2026
Exercise-based cardiac rehabilitation after stroke and the risk of incident dementia: an observational study from a global federated network.
Observational study in European stroke journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
9 authors.
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Abstract
introductionDementia is a common and disabling complication after stroke. Exercise-based cardiac rehabilitation (EXCR) may influence vascular and inflammatory mechanisms relevant to cognitive decline. We investigated the association between EXCR initiation after stroke and incident dementia. PATIENTS AND
methodsUsing TriNetX, we identified adults with ischaemic stroke or TIA. Patients with recorded ICD-10-CM codes indicating an NIHSS score ≥ 16 were excluded from the primary analysis. Patients initiating EXCR within 6 months were compared with those without documented post-index EXCR. Propensity score matching balanced demographics, comorbidities, medication use and available stroke-severity measures. Outcomes were assessed at 3 and 5 years.
resultsThe unmatched cohorts included 4226 patients initiating EXCR (mean age, 64.7 years; 60.8% male) and 1,889,796 without EXCR (mean age, 66.3 years; 48.2% male). After matching, 4138 patients remained in each cohort. At 5 years, EXCR was associated with lower hazards of incident dementia (HR, 0.70; 95% CI, 0.59-0.82), all-cause mortality (HR, 0.50; 95% CI, 0.45-0.55) and recurrent stroke (HR, 0.75; 95% CI, 0.61-0.91), but a higher hazard of rehospitalisation (HR, 1.21; 95% CI, 1.06-1.38); no significant association was observed for acute myocardial infarction. The association with incident dementia remained consistent across sensitivity analyses. DISCUSSION: The observed association with lower dementia risk suggests that the potential benefits of post-stroke EXCR may extend beyond cardiovascular and functional outcomes.
conclusionsEXCR initiation after ischaemic stroke or TIA was associated with a lower hazard of incident dementia. This association remained consistent across the 3-year, 30-day landmark, 1-year lagged and all-stroke-severity sensitivity analyses.
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