Post-stroke cognitive impairment remains highly prevalent and disabling despite state-of-the-art stroke treatment.

Gallucci, Laura; Sperber, Christoph; Guggisberg, Adrian G; Kaller, Christoph P; Heldner, Mirjam R; Monsch, Andreas U; Hakim, Arsany; Silimon, Norbert; Fischer, Urs; Arnold, Marcel; Umarova, Roza (2024). Post-stroke cognitive impairment remains highly prevalent and disabling despite state-of-the-art stroke treatment. (In Press). International journal of stroke(17474930241238637), p. 17474930241238637. SAGE 10.1177/17474930241238637

Full text not available from this repository. (Request a copy)


State-of-the-art stroke treatment significantly reduces lesion size and stroke severity, but it remains unclear whether these therapeutic advances have diminished the burden of post-stroke cognitive impairment (PSCI).


In a cohort of patients receiving modern state-of-the-art stroke care including endovascular therapy, we assessed the frequency of PSCI and the pattern of domain-specific cognitive deficits, identified risk factors for PSCI, and determined the impact of acute PSCI on stroke outcome.


In this prospective monocentric cohort study, we examined patients with first-ever anterior circulation ischemic stroke without pre-stroke cognitive decline, using a comprehensive neuropsychological assessment ≤ 10 days after symptom onset. Normative data were stratified by demographic variables. We defined PSCI as at least moderate (< 1.5 SD) deficits in ≥ 2 cognitive domains. Multivariable regression analysis was applied to define risk factors for PSCI.


We analyzed 329 non-aphasic patients admitted from December, 2020 to July, 2023 (67.2±14.4 years old, 41.3% female, 13.1±2.7 years of education). Though most patients had mild stroke (median NIHSS 24h=1.00 [0.00; 3.00]; 87.5% with NIHSS ≥ 5), 69.3% of them presented with PSCI 2.7±2.0 days post-stroke. The most severely and often affected cognitive domains were verbal learning, episodic memory, executive functions, selective attention, and constructive abilities (39.1%-51.2% of patients), whereas spatial neglect was less frequent (18.5%). The risk of PSCI was reduced with more years of education (odds ratio [OR] 0.47, 95% CI: 0.23-0.99) and right hemispheric lesions (OR 0.47, 95% CI: 0.26-0.84), and increased with stroke severity (NIHSS 24h, OR 4.19, 95% CI: 2.72-6.45), presence of hyperlipidemia (OR 1.93, 95% CI: 1.01-3.68), but was not influenced by age. After adjusting for stroke severity and depressive symptoms, acute PSCI was associated with poor functional outcome (modified Rankin Scale > 2, F=13.695, p<0.001) and worse global cognition (MoCA-score, F=20.069, p<0.001) at 3 months post-stroke.


Despite modern stroke therapy and many strokes having mild severity, PSCI in the acute stroke phase remains frequent and associated with worse outcome. The most prevalent were learning and memory deficits. Cognitive reserve operationalized as years of education independently protects post-stroke cognition.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

Graduate School:

Graduate School for Health Sciences (GHS)

UniBE Contributor:

Gallucci, Laura, Sperber, Christoph Michael, Guggisberg, Adrian (A), Heldner, Mirjam Rachel, Hakim, Arsany, Silimon, Norbert, Fischer, Urs Martin, Arnold, Marcel, Umarova, Roza


600 Technology > 610 Medicine & health








Pubmed Import

Date Deposited:

06 Mar 2024 09:06

Last Modified:

23 Mar 2024 00:15

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Acute Cognitive reserve Ischaemic stroke Memory deficit Neuropsychological profiles Post-stroke cognitive impairment Risk factors Vascular cognitive impairment Years of education


Actions (login required)

Edit item Edit item
Provide Feedback