USELESS! You tell us nothing on how to get cognitive recovery! Ph. D.s and still no brains at all!
You're supposed to solve problems, NOT just describe them you blithering idiots. Hoping comeuppance hits you really hard when you are the 1 in 4 per WHO that has a stroke!
Longitudinal Trajectories of Global and Domain-Specific Cognition After Stroke Using the Oxford Cognitive Screen
Abstract
BACKGROUND:
Cognitive impairment is common after stroke and linked to poor outcomes, yet long-term recovery or decline, particularly across specific cognitive domains, remains unclear. Most studies use brief global screeners with short follow-up, limiting insight into recovery patterns. This study aimed to characterize domain-specific cognitive trajectories over ≥2 years poststroke and identify predictors of persistent impairment.
METHODS:
Participants were recruited at a regional acute stroke unit (John Radcliffe Hospital, Oxford, United Kingdom; 2012–2019) and assessed acutely, at 6 months, and ≥2 years poststroke. The Oxford Cognitive Screen was administered at all timepoints. Global impairment severity was quantified by the proportion of Oxford Cognitive Screen subtasks impaired. Logistic mixed-effects models examined longitudinal change and predictors of domain-specific impairments (language, memory, attention, executive function, and number processing). Latent class growth analysis identified distinct cognitive trajectories. Models were adjusted for acute cognitive impairment severity and time.
RESULTS:
Of 866 patients assessed acutely, 105 were followed up at ≥2 years (98 with complete Oxford Cognitive Screen data; median, 4.1 [interquartile range, 3.3] years; mean age, 69 years, 41% female). Cognitive impairment severity improved substantially by 6 months (β=−0.11; P<0.001) and further long-term (β=−0.15; P<0.001). Acute impairment severity strongly predicted long-term outcomes (β=0.50; P<0.001), while demographic and vascular factors explained minimal variance. Latent class growth analysis identified 4 overall trajectories: no or mild acute impairment with stability (47.6%), moderate-improving (32.3%), large improvement (15.2%), and decline (4.8%). Domain-specific improvements were greatest in memory (odds ratio, 16.40 [95% CI, 5.52–48.7]) and language (odds ratio, 8.17 [95% CI, 3.17–21.1]), more limited in attention (odds ratio, 5.41 [95% CI, 2.52–11.6]) and executive function (odds ratio, 4.14 [95% CI, 1.96–8.75]). Domain models revealed additional classes of persistent or delayed recovery, particularly in executive function and attention.
CONCLUSIONS:
Cognitive recovery is most pronounced within 6 months and continues across domains though executive dysfunction often persists. Acute impairment severity best predicted long-term outcomes, while vascular and demographic factors were less informative. Distinct trajectory classes highlight the need for individualized, long-term cognitive monitoring to guide rehabilitation and prognostication. These findings underscore the importance of long-term cognitive follow-up in stroke care and provide empirical benchmarks for recovery across domains.
Graphical Abstract
Cognitive impairment is common following stroke1,2 and frequently contributes to poor functional outcomes,3,4 increased dependency,5 and reduced quality of life.4 While many individuals experience some degree of cognitive recovery, others may show persistent impairment or delayed decline.3,6 However, the long-term trajectories of change across different cognitive domains remain poorly understood.7 This is partly due to cognitive deficits often being overlooked beyond the immediate postacute period unless dementia develops, which is not an inevitable outcome.6,8,9
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