Dementia blood biomarkers in the context of post‐stroke cognitive outcomes: Systematic review and evidence synthesis

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INTRODUCTION: The prognostic value of emerging dementia-related blood-based biomarkers for post-stroke cognitive impairment is poorly understood. We addressed this critical gap in this systematic review. METHODS: Four databases were searched in March 2025 for studies of neurofilament light (NfL), glial fibrillary acidic protein (GFAP), amyloid beta (Aβ), tau, and placental growth factor (PlGF) in relation to post-stroke cognitive outcomes. Risk of bias, narrative synthesis, and meta-analysis were performed. RESULTS: Eighteen studies were included, eleven assessing NfL. Meta-analysis of four studies (n = 2020) showed higher acute NfL was associated with worse cognition at 1-6 months (Z = -0.518, 95% confidence interval [CI] -0.684 to -0.351). Baseline GFAP was associated with worse cognition longitudinally, whereas results for amyloid and tau species were inconsistent between studies. Risk of bias was high. DISCUSSION: NfL and GFAP show the most consistent associations with post-stroke cognition, particularly acutely. Evidence for amyloid and tau was inconsistent between studies, and PlGF remains unexplored.

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