This study aimed to systematically review and meta-analyze the association between cognitive impairment and medication non-adherence in stroke patients. The review included 9 studies that met the inclusion criteria, with measures of cognitive impairment ranging from dementia diagnosis to standardized cognitive assessments, and medication adherence assessed through self-report or administrative databases. The majority of studies were of medium risk of bias, with two studies having low risk and one at high risk. The findings were mixed, with no evidence of an association between cognitive impairment and medication non-adherence when all studies were pooled. However, there was substantial heterogeneity, and sensitivity analyses based on different measures of cognitive impairment, adherence, and adjustment for covariates were conducted. The overall quality of evidence was rated as low, and the study concluded that further research using clear, standardized, and objective assessments is needed to clarify the association between cognitive impairment and medication non-adherence in stroke patients.This study aimed to systematically review and meta-analyze the association between cognitive impairment and medication non-adherence in stroke patients. The review included 9 studies that met the inclusion criteria, with measures of cognitive impairment ranging from dementia diagnosis to standardized cognitive assessments, and medication adherence assessed through self-report or administrative databases. The majority of studies were of medium risk of bias, with two studies having low risk and one at high risk. The findings were mixed, with no evidence of an association between cognitive impairment and medication non-adherence when all studies were pooled. However, there was substantial heterogeneity, and sensitivity analyses based on different measures of cognitive impairment, adherence, and adjustment for covariates were conducted. The overall quality of evidence was rated as low, and the study concluded that further research using clear, standardized, and objective assessments is needed to clarify the association between cognitive impairment and medication non-adherence in stroke patients.