Post-Stroke Cognitive Impairment and Predictors of Poor Clinical Outcome: A Cross-Sectional Study at Mayo Hospital Lahore, Pakistan

Abstract

Background: Post-stroke cognitive impairment is a common yet underrecognized neurological complication that substantially affects functional recovery, rehabilitation outcomes, and quality of life among stroke survivors. The burden of cognitive dysfunction following stroke remains inadequately explored in low- and middle-income countries, including Pakistan, where routine neurocognitive screening is not consistently integrated into stroke care. Objective: To determine the frequency of post-stroke cognitive impairment and identify predictors of poor clinical outcomes among stroke survivors presenting to a tertiary care hospital in Pakistan. Methods: This cross-sectional observational study was conducted at the Department of Neurology, Mayo Hospital Lahore, Pakistan. A total of 68 clinically stable post-stroke patients were consecutively enrolled. Demographic characteristics, vascular comorbidities, stroke severity using the National Institutes of Health Stroke Scale (NIHSS), and cognitive outcomes were assessed through structured clinical evaluation. Inferential statistical analysis was performed using logistic regression, and results were reported as odds ratios (ORs), relative risks (RRs), 95% confidence intervals (CIs), and p-values. Results: Post-stroke cognitive impairment was identified in 58.8% of patients, including mild impairment in 35.3%, moderate impairment in 16.2%, and severe impairment in 7.4% of participants. Poor clinical outcomes were observed in 38.2% of patients, while persistent cognitive impairment at follow-up occurred in 51.5%. Higher NIHSS scores (OR: 3.85; 95% CI: 1.85–8.02; p<0.001), lower educational status (OR: 0.52; 95% CI: 0.34–0.79; p=0.002), baseline cognitive impairment (RR: 1.96; 95% CI: 1.24–3.08; p=0.004), diabetes mellitus (RR: 1.34; 95% CI: 1.03–1.74; p=0.031), and older age (OR: 1.04; 95% CI: 1.00–1.08; p=0.047) were significantly associated with poor clinical outcomes. Conclusion: Post-stroke cognitive impairment was highly prevalent among stroke survivors and was strongly associated with adverse neurological and functional outcomes. Early neurocognitive assessment and targeted multidisciplinary rehabilitation strategies may improve long-term recovery and quality of life in this vulnerable population.