The association between cognitive dysfunction and frailty in patients with acute ischemic stroke is partially mediated by fall risk and independent living skills, with cognitive dysfunction having a direct effect on frailty accounting for 61.54% of the total effect and an indirect effect through fall risk and independent living skills accounting for 38.46%.
Key Findings
Results
Cognitive dysfunction was significantly negatively correlated with both fall risk and frailty, and positively correlated with independent living skills in AIS patients.
Cognitive dysfunction and fall risk: r = -0.249, P < .001
Cognitive dysfunction and frailty: r = -0.376, P < .001
Cognitive dysfunction and independent living skills: r = 0.315, P < .001
Data were collected from consecutively enrolled hospitalized AIS patients from August 2023 to December 2024 in the neurology department of a tertiary care hospital
Results
Fall risk was significantly positively correlated with frailty and significantly negatively correlated with independent living skills.
Fall risk and frailty: r = 0.391, P < .001
Fall risk and independent living skills: r = -0.448, P < .001
Fall risk was assessed using the Morse Fall Scale
Results
Independent living skills were significantly negatively correlated with frailty in AIS patients.
Independent living skills and frailty: r = -0.478, P < .001
Independent living skills were assessed using the Barthel Index Scale
Frailty was assessed using the Edmonton Frail Scale
Results
Cognitive dysfunction had a direct effect on frailty that accounted for the majority of the total effect.
Direct effect of cognitive dysfunction on frailty: -0.032
Total effect of cognitive dysfunction on frailty: -0.052
The direct effect accounted for 61.54% of the total effect
Mediation analyses were conducted using IBM SPSS 29.0 and the PROCESS macro (version 4.1, Model 6)
Results
Fall risk and independent living skills together partially mediated the relationship between cognitive dysfunction and frailty.
Total indirect effect: -0.020, contributing to 38.46% of the total effect
Fall risk and independent living skills exerted a partial mediating role in the relationship between cognitive dysfunction and frailty
This was a chain (serial) mediation model (Model 6), meaning fall risk and independent living skills acted as sequential mediators
Convenience sampling was used to recruit participants from a single tertiary care hospital
Methods
Cognitive assessment was performed using the Montreal Cognitive Assessment-Basic Scale in a consecutive sample of hospitalized AIS patients.
Participants were consecutively enrolled from August 2023 to December 2024
Patients were from the neurology department of a tertiary care hospital
Convenience sampling was used
Standardized assessment instruments were used including the General Information Questionnaire, Montreal Cognitive Assessment-Basic Scale, Morse Fall Scale, Barthel Index Scale, and Edmonton Frail Scale
What This Means
This research suggests that in patients who have had an acute ischemic stroke (a stroke caused by a blood clot blocking blood flow to the brain), cognitive problems — difficulties with thinking, memory, and reasoning — are linked to a higher likelihood of developing frailty, a condition characterized by weakness, exhaustion, and reduced ability to recover from illness. The study examined 164 hospitalized stroke patients and found that the relationship between cognitive problems and frailty is not entirely direct; rather, it is partly explained by two intermediate factors: increased risk of falling and reduced ability to perform daily activities independently.
Specifically, the study found that cognitive dysfunction contributes to frailty both directly (accounting for about 62% of the total effect) and indirectly through a chain reaction: cognitive problems raise the risk of falls, which in turn reduces a person's ability to live independently, which then contributes to frailty. Together, fall risk and loss of independent living skills explained about 38% of the overall relationship between cognitive dysfunction and frailty. All of these relationships were statistically significant.
This research suggests that targeting cognitive function in stroke patients may have downstream benefits beyond just improving thinking and memory — it may also reduce fall risk, help patients maintain independence in daily activities, and ultimately lessen the development of frailty. Clinically, this implies that comprehensive stroke rehabilitation programs that address cognitive impairment alongside fall prevention and functional independence training may be particularly effective in reducing frailty outcomes in this patient population.
Yang J, Liu S, He Y, Zhang Y, Niu Y, Sun H, et al.. (2026). Chain mediation analysis of fall risk and independent living skills in patients with acute ischemic stroke between cognitive dysfunction and frailty.. Medicine. https://doi.org/10.1097/MD.0000000000049177