Hidden Cognitive Deficits in Young Stroke Survivors With Excellent Functional Recovery: A Case-Control Study

Abstract

Introduction

Cognitive dysfunction is relatively common among younger stroke survivors, even in cases where physical recovery appears favorable. However, existing research often lacks methodological rigor, particularly in terms of comprehensive neuropsychological assessment within a well-controlled cohort. The present study is aimed at addressing this gap by assessing cognitive functioning in a clinically recovered group of younger stroke survivors using in-depth evaluation methods at a time point when spontaneous recovery is expected to have stabilized.

Participants and Methods

We compared the cognitive performance of 20 working-age stroke survivors (mean age 47.7, SD = 6.3), who had experienced a relatively mild ischemic stroke (median NIHSS 3; IQR 2–5) located in the middle cerebral artery (MCA) territory, to 20 healthy controls matched for age, sex, and education. Time since stroke was a median of 2 years (IQR 1–3.25). All participants underwent a comprehensive neuropsychological assessment covering most functionally relevant cognitive domains.

Results

Stroke survivors showed significantly poorer performance than controls in verbal learning and recall, simple attentional processing, and processing speed, as well as in most tests measuring executive functions. Analysis of individual profiles showed that cognitive dysfunction was present in nearly half of the stroke survivors, with notable variability in the severity of impairment.

Discussion and Conclusion

Despite excellent functional recovery and a high rate of return to work, stroke survivors performed noticeably worse than controls across several functionally important cognitive domains even years after a relatively mild stroke. While more severe dysfunction was evident in only a minority, subtle deficits may still impact daily functioning depending on individual life demands. These findings underscore the importance of recognizing potential cognitive difficulties after mild stroke and highlight the value of comprehensive neuropsychological assessment to provide targeted support.