Longitudinal Trajectories of Global and Domain-Specific Cognition After Stroke Using the Oxford Cognitive Screen

 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

Elise Milosevich, DPhil, Andrea Kusec, PhD https://orcid.org/0000-0003-0128-4677, 

Sarah T. Pendlebury, DPhil https://orcid.org/0000-0003-3603-8388, and Nele Demeyere, PhD https://orcid.org/0000-0003-0416-5147 nele.demeyere@ndcn.ox.ac.uk

Author Info & Affiliations

New online

https://doi.org/10.1161/STROKEAHA.125.054555

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

Adaptive changes in body-specific attention to the paretic and nonparetic feet contribute to dynamic stability during walking in patients with chronic hemiparesis from stroke

 If anything here gets survivors recovered I'm not seeing it. Descriptions of something don't deliver recovery which is the whole fucking point of stroke research!

Adaptive changes in body-specific attention to the paretic and nonparetic feet contribute to dynamic stability during walking in patients with chronic hemiparesis from stroke

Author links open overlay panel, , , , 

https://doi.org/10.1016/j.heliyon.2026.e44999Get rights and content

Under a Creative Commons license

Open access

Highlight

• •
  Body-specific attention to the nonparetic foot enhances dynamic stability.
• •
  Severe tactile dysfunction increased body-specific attention to paretic foot.
• •
  Adaptive changes in body-specific attention support gait control.

Abstract

Background

Body-specific attention contributes to motor control; however, it is unclear how body-specific attention to the lower limbs is related to dynamic stability during walking.

Research question

Is body-specific attention to both paretic and nonparetic feet associated with dynamic stability during walking in patients with chronic hemiparesis?

Methods

This cross-sectional study included 16 patients with chronic hemiparesis, including those with sensory disorders who were capable of walking independently. Body-specific attention was measured using a previously reported visual stimulus detection task. Whole-body angular momentum in the coronal plane, an indicator of dynamic stability during walking, was evaluated using a three-dimensional motion analysis system and force plates. Correlations between body-specific attention, gait parameters, and the subitems of Stroke Impairment Assessment Set were analyzed using either the Pearson product-moment correlation coefficient or the Spearman's rank correlation coefficient.

Results

Body-specific attention to the nonparetic foot was negatively correlated with the coronal whole-body angular momentum (r = −0.511), and positively correlated with vertical ground reaction force (r = 0.815) in the second half of the single-stance phase on the paretic side. These results suggest that increased body-specific attention to the nonparetic foot may be associated with greater dynamic stability during walking. In addition, body-specific attention to the paretic foot was negatively correlated with the tactile sensation in the paretic foot (r = −0.576). This indicates that increased body-specific attention to the paretic foot was present in patients with severe tactile function impairment.

Significance

The findings suggest that adaptive changes in body-specific attention to paretic and nonparetic feet, depending on the severity of tactile dysfunction, are associated with dynamic stability during walking.

Relationship between lower limb muscle coordination and knee flexion angle during the swing phase of gait in post-stroke individuals

 THIS DOES NOTHING TO GET SURVIVORS RECOVERED! If you can't write EXACT protocols for guaranteed recovery, then get the hell out of stroke! Describing something does nothing for survivors! And you are too blitheringly stupid to see that; along with your mentors and seniors researchers! I'd have you all fired!

Relationship between lower limb muscle coordination and knee flexion angle during the swing phase of gait in post-stroke individuals

• Taiga Karino,
• Toshiyuki Aoyama,
• Kenichi Yoshikawa,
• Kiyoshige Ishibashi &
• Yutaka Kohno 

We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

Abstract

Background

Stroke patients with hemiplegia often show inefficient gait patterns, including reduced knee flexion during the swing phase, which may increase fall risk. Post-stroke gait frequently involves merged muscle synergies that affect lower limb kinematics. However, it remains unclear how muscle synergy merging and fractionation relate to knee flexion during the swing phase. Therefore, this study aimed to examine the association between knee flexion during the swing phase and muscle synergy merging and fractionation patterns in patients with stroke.

Methods

The study comprised 21 stroke patients with hemiplegia. Surface electromyography was recorded from eight lower-limb muscles on the paretic side during comfortable gait. Maximum knee flexion angle (MKFA) during the swing phase was measured using a markerless motion capture system. Using non-negative matrix factorization, the number of muscle synergies, their spatiotemporal structure were calculated. Participants were classified into a low-synergy group (LS; n = 5; one or two synergies) or a high-synergy group (HS; n = 16; three synergies). Group comparisons of MKFA during the swing phase were performed. Furthermore, we investigated whether muscle synergies of the HS group could be fractionations of those of the LS group.

Results

The HS group showed significantly greater MKFA compared with the LS group (p = 0.032). In the HS group, the ankle plantar flexors constituted an independent muscle synergy, whereas in the LS group, these muscles had high weightings within a muscle synergy associated with load response. Furthermore, the independent muscle synergies observed in the HS group were shown to be fractionated from the merged muscle synergies present in the LS group.

Conclusion

Our results showed that merged muscle synergies were associated with reduced MKFA during the swing phase, whereas an independent synergy involving the plantar flexors was associated with greater knee flexion. These findings suggest that fractionation of the plantar flexor synergy may be important for improving knee kinematics after stroke and could inform targeted rehabilitation strategies. Given the relatively small and imbalanced sample size, cautious interpretation of the findings is warranted. Further studies with larger, balanced samples are needed to further strengthen the evidence for these findings.

Targeting the microbiota-gut-brain axis in post-stroke insomnia: a phase-dependent therapeutic framework

 Wonderful descriptions; but complete failure at producing anything for stroke recovery!

Targeting the microbiota-gut-brain axis in post-stroke insomnia: a phase-dependent therapeutic framework

• 

  Yumin Zhou

• Y

  Yingying Huang

• 

  Xia Bi *

• Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China

Abstract

Post-stroke insomnia (PSI) is a critical biological barrier to neurorehabilitation afflicting over half of all stroke survivors. Traditional sedatives often force clinicians into a therapeutic dilemma between sleep efficacy and cognitive suppression. The microbiota-gut-brain (MGB) axis has recently emerged as a transformative target to resolve this impasse. Acute stroke triggers profound autonomic dysfunction, causing immediate intestinal barrier collapse. This “leaky gut” facilitates the systemic translocation of lipopolysaccharides (LPS) and activates the NLRP3 inflammasome. The resulting inflammatory storm hijacks central tryptophan metabolism via the indoleamine 2,3-dioxygenase (IDO) enzyme. This “tryptophan steal” diverts serotonin precursors toward neurotoxic kynurenine pathways, driving severe cortical hyperarousal. Sleep fragmentation then prevents the glymphatic system from clearing metabolic waste, further exacerbating neuroinflammation. To break this vicious cycle of neurotoxicity, we propose a phase-dependent therapeutic framework. During the highly vulnerable acute phase, interventions must prioritize gut barrier protection using postbiotics to mitigate infection risks under CNS injury-induced immunodepression (CIDS), often discussed as stroke-induced immunosuppression. As patients enter the chronic phase, therapy shifts toward metabolic restoration using live therapeutics, such as washed microbiota transplantation (WMT) and next-generation psychobiotics like Akkermansia muciniphila. Targeting the MGB axis offers a mechanism-based strategy to achieve precision sleep medicine, restoring the biological foundation necessary for optimal neuroplasticity and recovery.

1 Introduction

1.1 The silent epidemic: beyond symptomology

Stroke remains a formidable global health challenge, consistently ranking among the leading causes of mortality and long-term adult disability worldwide (GBD 2019 Stroke Collaborators, 2021; Feigin et al., 2025). While the advent of hyper-acute recanalization therapies—such as mechanical thrombectomy and intravenous thrombolysis—has improved acute outcomes, these advances have coincided with a growing population of survivors living with chronic sequelae (GBD 2019 Stroke Collaborators, 2021; Feigin et al., 2025). Among these, sleep–wake disturbances are pervasive yet frequently underestimated in routine clinical practice, often overshadowed by more visible motor deficits (Khot and Morgenstern, 2019). Epidemiological evidence suggests that sleep problems affect roughly half of stroke survivors, consistent with pooled estimates of poor sleep quality after stroke and broader post-stroke sleep-disorder burden (Khot and Morgenstern, 2019; Luo et al., 2023). Of these disorders, post-stroke insomnia (PSI) is commonly reported and can persist, presenting a barrier to effective neurorehabilitation (Wang et al., 2024; Sun et al., 2026). PSI is characterized not merely by difficulties in sleep initiation, but also by fragmentation of sleep continuity and non-restorative rest (Wang et al., 2024). The clinical ramifications of untreated PSI extend beyond subjective fatigue or daytime somnolence; disrupted sleep after stroke has been associated with poorer functional outcomes and increased risk of adverse vascular events in observational and review evidence (Khot and Morgenstern, 2019). Sleep is a fundamental physiological pillar for neuroplasticity and memory consolidation, and sleep disruption may therefore hinder recovery processes after stroke (Khot and Morgenstern, 2019). Indeed, disrupted sleep in the post-stroke period has been linked to worse functional recovery and mood and cognitive outcomes, supporting proactive recognition and targeted management rather than passive observation.

More at link.

Nearly half of patients with hemorrhagic stroke experience headache

 So, you described something and incompetently provided NO EXACT NEXT STEPS TO SOLVE THE PROBLEM! In the business world that would be grounds for immediate firing. Aren't you glad you're in the absolutely incompetent stroke medical world?

Nearly half of patients with hemorrhagic stroke experience headache

Key takeaways:

• The systematic review included 24 studies and 4,688 adults with hemorrhagic stroke.
• There were no significant associations between headache and diabetes mellitus, hypertension, alcoholism or previous headache.

Nearly half of all patients with hemorrhagic stroke also experience headache across its acute and chronic phases that could contribute to long-term morbidity, according to a review published in Headache.

Yet the prevalence of headache varied substantially across populations and clinical settings, Bradley Ong, MD, adult neurology resident at Neurological Institute, Cleveland Clinic, and colleagues wrote.

Data derived from Ong B, et al. Headache. 2025; doi:10.1111/head.70008.

“In clinical practice, headaches after hemorrhagic stroke came up quite often in our clinical practice, but they were rarely addressed,” Ong told Healio.

Most treatment after stroke focuses on motor recovery and preventing its recurrence, he said, with headache treated as an incidental or transient symptom.

Bradley Ong

“When we looked at the literature, there was no clear, consolidated picture of how common these headaches are or how long they last,” Ong said. “That gap is what motivated this study.”

Ong and colleagues conducted a systematic review and meta-analysis that included 24 peer-reviewed, observational studies from Medline, Embase and CENTRAL with 4,688 adults (mean age, 56.9 years; weighted mean, 58.2% women) with hemorrhagic stroke.

“The most striking finding was how common headaches are,” Ong said. “Nearly half of patients with hemorrhagic stroke experience headache, and more than one-third go on to have persistent headaches months or years later.”

Overall, 46.1% (95% CI, 36.3% to 56.1%) of these patients experienced headache after their stroke. Eleven studies (n = 2,481) found that 55.9% of patients (95% CI, 41.1% to 70.1%) experienced acute headache. Thirteen studies (n = 2,207) found that 36.7% of patients (95% CI, 25.6% to 48.5%) had persistent headache.

“This challenges the assumption that headache is mainly an ‘acute’ symptom, especially in hemorrhagic stroke,” Ong said.

Specific prevalences of headache included 58.3% (95% CI, 44.4% to 71.6%) for those with subarachnoid hemorrhage (SAH) and 36.1% (95% CI, 26.7% to 46%) for those with intracerebral hemorrhage (ICH).

Prevalence of severe headaches included 42.7% (95% CI, 15.8% to 72.1%) among those whose headaches were acute/subacute and 14.3% (95% CI, 10.4% to 18.7%) among those whose headaches were persistent.

With an overall I2 of 96.7%, the researchers said their findings indicated substantial heterogeneity in these pooled prevalence estimates, with no statistically significant differences based on study design, population, geography, Human Developmental Index or risk for bias.

Further, Ong and colleagues said there were no significant associations between risk for headache and female sex, nor were there any significant associations with history of diabetes mellitus, hypertension, alcoholism or previous headache.

“Another important finding was that headache at stroke onset strongly predicted chronic headache, which gives us an early clinical signal we can actually act on,” Ong said.

The odds ratio for post-stroke headache among patients with headache at stroke onset was 1.7 (OR = 1.7; 95% CI, 1.4-2.05). Also, the odds ratio for post-stroke headache among patients with lobar ICH was 1.93 (95% CI, 1.08-3.44).

There were no significant associations between headache risk and cortical ICH or delayed cerebral ischemia. Also, there were no significant associations between headache risk and the presence of an anterior circulation aneurysm among patients with SAH.

Patients with atrial fibrillation had less risk for headache (OR = 0.59; 95% CI, 0.37-0.95), which the researchers attributed to differences in stroke severity and symptom reporting and not to any direct protective effect.

Noting that the prevalence of headache among patients with hemorrhagic stroke exceeds the prevalence of other primary headache disorders among the general population, with substantial variations by population and clinical settings, the researchers called these headaches “common” as well as “persistent and disabling.”

Ong said that clinicians can use these findings to improve outcomes for patients with stroke.

“Clinicians should ask about headache routinely, both in the hospital and during follow-up. Headache should be treated as a meaningful post-stroke complication,” he said.

“Patients who report headache early may benefit from closer monitoring and earlier referral to headache care,” he continued. “Even simple steps like education and avoiding unnecessary opioid exposure can improve quality of life.

Looking ahead, the researchers called for studies with standardized diagnostic criteria, clearly defined populations and detailed headache characteristics into protective therapies and secondary prevention strategies.

“The next step is prospective, longitudinal studies using standardized headache definitions and patient-reported outcomes,” Ong said.

“We also need clinical trials focused specifically on post-stroke headache treatment, rather than extrapolating from primary headache disorders,” he added. “Ultimately, the goal is to integrate headache care into routine stroke recovery.”

For more information:

Bradley Ong, MD, can be reached at ongb@ccf.org.

Contralesional Motor Cortex: Key to Stroke Recovery?

 

But nothing here helps survivors get recovered. Describing something does no good, we need EXACT PROTOCOLS THAT DELIVER RECOVERY.

Contralesional Motor Cortex: Key to Stroke Recovery?

The human brain, with its intricate neural networks, continues to fascinate and baffle researchers, particularly in the realm of recovery following adverse events such as strokes. A recent scoping review highlighted in BMC Neuroscience delves into the role of the contralesional primary motor cortex in aiding upper limb recovery after a stroke. This development is particularly pivotal, given that strokes significantly impair motor functions, leading to long-term disability in numerous individuals. Studying the contralesional primary motor cortex offers a new lens through which we can understand post-stroke rehabilitation.

Strokes occur when the blood supply to part of the brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients. The consequences can be devastating, often resulting in the loss of motor functions, particularly in the limbs. Upper limb recovery becomes a critical goal in rehabilitation, as it heavily influences a person’s ability to carry out daily activities and ultimately impacts their quality of life. The contralesional primary motor cortex—the part of the brain that processes motor functions for the limbs opposite the side of body affected—holds promise in facilitating recovery from such debilitating conditions.

Researchers Hernan Fregni, Pattharawadee Suputtitada, and Victor Costa conducted this comprehensive review as part of their efforts to elucidate how the contralesional primary motor cortex contributes to functional recovery. Through the meticulous application of PRISMA-ScR guidelines—an established framework ensuring transparency and reproducibility in scoping reviews—they meticulously sifted through varied studies to extract pertinent findings. The synthesis of these studies offers critical insights into how contralesional regions can be harnessed to enhance rehabilitation strategies.

One of the most striking findings from this review is how the brain exhibits remarkable plasticity. Even after significant injury, the brain can adapt and reorganize itself to compensate for lost functions. This plasticity is particularly pronounced in the contralesional hemisphere, which, following the injury of the ipsilesional hemisphere—typically where the stroke occurs—can take over some motor tasks. This neural adaptation widens the horizon for therapeutic interventions, suggesting that targeted stimulation of the contralesional motor cortex could engender recovery pathways that were previously thought unattainable.

Moreover, the review meticulously highlights various therapeutic strategies aiming to exploit this contralesional connectivity. Rehabilitation techniques including transcranial magnetic stimulation (TMS) have emerged as frontrunners in modulating activity within the contralesional primary motor cortex. By using non-invasive brain stimulation techniques, therapists can enhance excitability in this area, thereby improving motor function. Such efficient stimulation protocols could provide a similar stimulus to the impaired areas of the brain, catalyzing the recovery process.

Additionally, the involvement of augmented feedback mechanisms in upper limb rehabilitation is worth noting. Studies included in the review reflect how feedback mechanisms, whether intrinsic or extrinsic, can significantly influence motor relearning and recovery. The contralesional primary motor cortex, capable of modifying its functional representation based on feedback from the environment, indicates that we might not only be able to recover lost motor functions but also optimize existing ones. Harnessing this feedback in therapeutic practices could lead to profound improvements in recovery trajectories.

Interestingly, the review also emphasizes the role of engaging patients in active rehabilitation practices. Motor imagery and mental practice, where patients visualize themselves performing movements, have been shown to engage the contralesional motor cortex, further underscoring the power of mental processes in recovery. These findings support a broader paradigm shift where cognitive engagement becomes a central tenet in rehabilitation, integrating both mental and physical stages in recovery protocols.

The clinical implications of this research are profound. With a clearer understanding of how the contralesional primary motor cortex facilitates recovery, therapists can tailor individualized rehabilitation protocols. These tailored approaches pivot from traditional methods, incorporating new dimensions such as virtual reality or gamified platforms that directly stimulate contralesional pathways, which can engage patients more effectively and promote better recovery outcomes.

A dynamic interplay between clinical techniques and neuroscience is evident, where researchers and practicing clinicians must collaborate closely. This scoping review nostalgically harkens to previous studies that highlighted the potential of the contralesional cortex, yet it provides a panoptic view of contemporary knowledge and outlines future directions for research. It poses essential questions regarding optimal stimulation parameters and the timing of interventions that are ripe for exploration.

As we look to the future, this research serves as an impetus for further studies aimed at unlocking the full potential of the contralesional primary motor cortex. Larger randomized controlled trials will likely refine the role of various rehabilitation strategies in exploiting this brain area effectively. The collective goal remains to enhance the quality of recovery for stroke patients, ultimately helping them regain independence and improve their quality of life.

In conclusion, the exploration of the contralesional primary motor cortex in relation to recovery from stroke represents an exciting frontier in neuroscience. The implications not only provide hope for individuals affected by strokes but also highlight a crucial intersection of clinical application and theory. Such advancements reinforce the necessity for continuous research and innovation, ensuring that recovery techniques remain ahead of the curve, aligning with our growing understanding of neuroplasticity and motor learning processes.

Subject of Research: The role of the contralesional primary motor cortex in upper limb recovery after stroke.

Article Title: The role of the contralesional primary motor cortex in upper limb recovery after stroke: a scoping review following PRISMA-ScR guidelines.

Article References:
Suputtitada, P., Costa, V. & Fregni, F. The role of the contralesional primary motor cortex in upper limb recovery after stroke: a scoping review following PRISMA-ScR guidelines.
BMC Neurosci 26, 31 (2025). https://doi.org/10.1186/s12868-025-00950-y

Image Credits: AI Generated

DOI: https://doi.org/10.1186/s12868-025-00950-y

Keywords: Stroke recovery, contralesional primary motor cortex, motor cortex plasticity, rehabilitation techniques, transcranial magnetic stimulation, motor imagery, neuroplasticity.

Tags: BMC Neuroscience scoping reviewbrain plasticity in stroke recoverycontralesional primary motor cortexenhancing quality of life post-strokeimpact of stroke on daily activitiesmotor function impairment due to strokeneural networks in stroke recoverypost-stroke rehabilitation strategiesrole of motor cortex in recoverystroke recovery mechanismsstroke-related long-term disabilitiesupper limb rehabilitation after stroke