Cognitive Outcome in Patients with Middle Cerebral Artery and Anterior Cerebral Artery Territory Ischaemic Stroke at a Tertiary Health Care Centre.

Abstract

Background: Stroke is a major cause of disability and mortality, often leading to both motor and cognitive impairments. Cognitive impairment is common among stroke survivors, with ischaemic strokes constituting the majority. While physical rehabilitation is emphasised, cognitive assessment remains underutilised in acute care.

Purpose: This study aimed to assess cognitive impairment in patients with ischaemic stroke affecting the anterior circulation using the Montreal Cognitive Assessment (MoCA) scale, and to correlate clinical variables with cognitive outcomes.

Methods: This observational study was conducted over 18 months at a tertiary healthcare centre in coastal Karnataka, India. Patients with first-ever ischaemic stroke involving the middle cerebral artery (MCA) and anterior cerebral artery (ACA) territories were included. Cognitive impairment was assessed using the MoCA scale within 1 week of stroke onset and again at 90 days. Clinical data such as NIHSS and mRS scores, as well as stroke subtype (via TOAST classification), were also collected.

Results: A total of 96 patients were included, with a mean age of 62.5 ± 10.3 years. At baseline, 55% of patients showed cognitive impairment, which improved at the 90-day follow-up (45% impaired). The most frequently affected domains were Attention (55%), Language (45%) and Executive function (50%). Factors such as older age, lower education level and higher NIHSS scores were associated with worse cognitive outcomes. Stroke aetiology (large-artery atherosclerosis and cardioembolism) was linked to more severe cognitive deficits. Aphasia was observed in 29 patients, and follow-up MoCA testing showed minimal cognitive improvement in this group.

Conclusion: Vascular cognitive impairment is a significant concern in ischaemic stroke patients. The MoCA scale is an effective tool for the early identification of cognitive impairment, even within the first week post-stroke. Age, education, NIHSS and mRS scores are critical predictors of post-stroke cognitive decline. Further studies are needed to refine cognitive assessment tools, especially for aphasic patients.