• Mijntje M I Schellekens, Ravi C S Springer, Esther M Boot, Jamie I Verhoeven, Merel S Ekker, Mayte E van Alebeek, BrouwersPaul J A MPJAMNeurology, Medisch Spectrum Twente, Enschede, The Netherlands., Renate M Arntz, Gert W van Dijk, GonsRob A RRARNeurology, Catharina Hospital, Eindhoven, The Netherlands., van UdenInge W MIWMNeurology, Catharina Hospital, Eindhoven, The Netherlands., Tom den Heijer, Julia H van Tuijl, Karlijn F de Laat, van NordenAnouk G WAGWNeurology, Amphia Hospital, Breda, The Netherlands., Sarah E Vermeer, Marian S G van Zagten, Robert J Van Oostenbrugge, WermerMarieke J HMJHNeurology, Leiden University Medical Centre, Leiden, The Netherlands.Neurology, University Medical Centre Groningen, Groningen, The Netherlands., Paul J Nederkoorn, Frank G van Rooij, Ido R van den Wijngaard, de KortPaul L MPLMNeurology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands., Frank-Erik De Leeuw, KesselsRoy P CRPCRadboud University Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands.Vincent Van Gogh Instituut for Psychiatry, Venray, The Netherlands.Department of Medical Psychology and Radboudumc Alzheimer Center, Radboud, and Anil M Tuladhar.
• Neurology, Radboudumc, Nijmegen, The Netherlands.
• J. Neurol. Neurosurg. Psychiatr. 2024 May 14; 95 (6): 571579571-579.

BackgroundLimited data exists on cognitive recovery in young stroke patients. We aimed to investigate the longitudinal course of cognitive performance during the first year after stroke at young age and identify predictors for cognitive recovery.MethodsWe conducted a multicentre prospective cohort study between 2013 and 2021, enrolling patients aged 18-49 years with first-ever ischaemic stroke. Cognitive assessments were performed within 6 months and after 1 year following the index event, covering seven cognitive domains. Composite Z-scores using normative data determined cognitive impairment (Z-score<-1.5). A Reliable Change Index (RCI) assessed cognitive recovery (RCI>1.96) or decline (RCI<-1.96).Results393 patients (median age 44.3 years, IQR 38.4-47.2) completed cognitive assessments with a median time interval of 403 days (IQR 364-474) between assessments. Based on RCI, a similar proportion of patients showed improvement and decline in each cognitive domain, while the majority exhibited no cognitive change. Among cognitively impaired patients at baseline, improvements were observed in processing speed (23.1%), visuoconstruction (40.1%) and executive functioning (20.0%). Younger age was associated with better cognitive recovery in visuoconstruction, and larger lesion volume was related to cognitive recovery in processing speed. No other predictors for cognitive recovery were identified.ConclusionsCognitive impairment remains prevalent in young stroke even 1 year after the event. Most patients showed no cognitive change, however, recovery may have occurred in the early weeks after stroke, which was not assessed in our study. Among initially cognitively impaired patients, cognitive recovery is observed in processing speed, visuoconstruction and executive functioning. It is still not possible to predict cognitive recovery in individual patients.© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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