Work

Exercise-based cardiac rehabilitation after stroke and the risk of incident dementia: an observational study from a global federated network

Year: 2026

Type: article

Abstract: INTRODUCTION: Dementia 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 METHODS: Using 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. RESULTS: The 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. CONCLUSIONS: EXCR 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.

Source: European Stroke Journal

DOI: 10.1093/esj/aakag127