Frequency of Cognitive Decline in Post-Stroke Patients

Abstract

Background: Cognitive impairment is a frequent but often overlooked complication in stroke survivors, impacting functional recovery, independence, and long-term quality of life. Existing data on post-stroke cognitive decline are limited in South Asian populations, where demographic and health system factors may influence prevalence and severity. Objective: To determine the frequency and severity of cognitive decline among post-stroke patients attending a tertiary care center in Pakistan using the Mini-Mental State Examination (MMSE), and to identify clinical and demographic risk factors associated with cognitive impairment. Methods: In this cross-sectional study, 179 patients aged 18–70 years with ischemic or hemorrhagic stroke at least six months previously were consecutively recruited from a neurology department over six months. Demographic and clinical information was collected, and cognitive function assessed with linguistically validated MMSE versions. Statistical analyses included group comparisons and multivariate associations using appropriate inferential tests. Results: Cognitive decline (MMSE <24) was identified in 65.4% of participants, with mild, moderate, and severe impairment observed in 38.5%, 18.4%, and 8.4% respectively. Significant risk factors included older age (p<0.001), hemorrhagic stroke (p=0.048), longer post-stroke duration (p=0.032), and diabetes mellitus (p=0.008), while gender and other comorbidities were not significant. Conclusion: Cognitive decline affects a majority of post-stroke patients in this South Asian cohort, especially those with advanced age, hemorrhagic stroke, longer recovery interval, and diabetes. Routine screening and targeted rehabilitation are recommended to improve outcomes.