The mediating role of activities of daily living in the association between nutritional risk and cognitive function among stroke survivors: a cross-sectional study.

BACKGROUND: Nutritional risk is linked to poorer cognitive function in stroke patients, but whether this association is mediated by other factors remains unclear. The purpose of this study is to examine the relationship between nutritional risk and cognitive function, and to evaluate whether activities of daily living (ADL) mediate this association. METHODS: A cross-sectional design with convenience sampling was employed to enroll stroke patients from a tertiary hospital in Sichuan, China (January-June 2025). Data were collected using the Nutritional Risk Screening 2002, the Barthel Index, and the Mini-Mental State Examination. Mediation analysis was performed using bootstrap methods, adjusting for sociodemographic and clinical characteristics. Sensitivity analyses were conducted using the E-value and sequential ignorability to test the robustness of the mediating effect. RESULTS: A total of 472 stroke patients were enrolled with a mean age of 66.99 ± 11.52 years. The mean scores were 2.68 ± 0.99 for nutritional risk, 60.35 ± 20.47 for activities of daily living, and 19.08 ± 7.65 for cognitive function. After adjusting for covariates, the direct effect of nutritional risk on cognitive function was -1.40 (95% CI: -2.231 to -0.539; p = 0.001). An indirect effect mediated by ADL was observed (β = -0.44, 95% CI: -0.870 to -0.039; p = 0.040), which accounted for 24.0% of the total effect. Sensitivity analyses yielded an E-value of 1.29 for the indirect effect, with a critical ρ of 0.4 required to nullify the mediation. CONCLUSION: ADL partially mediates the association between nutritional risk and cognitive function in stroke survivors. Future prospective studies are needed to evaluate whether interventions targeting ADL are associated with improved cognitive outcomes.