Abstract
Post-stroke cognitive impairment (PSCI) is a common consequence of stroke and is associated with reduced functional
independence, poorer quality of life, and lower effectiveness of rehabilitation. PSCI results from the interaction of acute vascular
injury, network disconnection, cerebral small vessel disease, and systemic risk factors.
Objective. To summarize current evidence on the pathophysiological mechanisms of PSCI, approaches to screening and
prognostication, and to analyze the evidence base for cognitive rehabilitation, with a particular focus on digital and multimodal
interventions.
Results. Based on publications from 2021-2025, the risk and severity of PSCI are determined not only by stroke location but also
by markers of cerebral small vessel disease, particularly the volume and strategic distribution of white matter hyperintensities, as
well as measures of white matter integrity assessed by diffusion tensor imaging. Systematic cognitive screening in both the acute
and chronic stages, with repeated follow-up assessments and a low threshold for referral to comprehensive neuropsychological
evaluation, is recommended. Contemporary rehabilitation strategies include domain-specific cognitive training, computerassisted
programs, virtual reality, and telerehabilitation, which may increase training intensity and accessibility. Non-invasive
brain stimulation (rTMS/tDCS) is considered a promising adjuvant to cognitive rehabilitation; however, further standardization
of protocols and high-quality randomized controlled trials are required.
Conclusions. PSCI has a multifactorial pathogenesis and requires a personalized, multidisciplinary management approach that
integrates secondary prevention of vascular events, early identification of cognitive deficits, and structured cognitive rehabilitation.
Multimodal programs combining digital technologies, telerehabilitation, and, in selected cases, neuromodulation appear to be
the most promising strategies for improving cognitive outcomes after stroke.
References
El Husseini N, Katzan I, Rost NS, et al. Cognitive impairment after ischemic and hemorrhagic stroke: a scientific statement from the American Heart Association/American Stroke Association. Stroke. 2023;54(6):e272–e291. doi:10.1161/STR.0000000000000430.
Quinn TJ, Richard E, Teuschl Y, et al. European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment. Eur Stroke J. 2021;6(3):I–XXXVIII. doi:10.1177/23969873211042192.
Rost NS, Brodtmann A, Pase MP, et al. Post-stroke cognitive impairment and dementia. Circ Res. 2022;130(8):1252–1271. doi:10.1161/ CIRCRESAHA.122.319951.
Huang YY, Chen SD, Leng XY, et al. Post-stroke cognitive impairment: epidemiology, risk factors, and management. J Alzheimers Dis. 2022;86(3):983–999. doi:10.3233/JAD-215644.
Lo JW, Crawford JD, Desmond DW, et al; STROKOG Collaboration. Long-term cognitive decline after stroke: an individual participant data meta-analysis. Stroke. 2022;53(4):1318–1327. doi:10.1161/STROKEAHA.121.035796.
de Kort FAS, Coenen M, Weaver NA, et al. White matter hyperintensity volume and poststroke cognition: an individual patient data pooled analysis of 9 ischemic stroke cohort studies. Stroke. 2023;54(12):3021–3029. doi:10.1161/STROKEAHA.123.044297.
Coenen M, Kuijf HJ, Weaver NA, et al. Strategic white matter hyperintensity locations associated with post-stroke cognitive impairment: a multicenter study in 1568 stroke patients. Int J Stroke. 2024. doi:10.1177/17474930241252530.
Ball T, et al. Lesion network mapping of post-stroke cognitive syndromes. Nat Commun. 2023. doi:10.1038/s41467-023-37330-1.
Egle M, Hilal S, Tuladhar AM, et al. Prediction of dementia using diffusion tensor MRI measures: the OPTIMAL collaboration. J Neurol Neurosurg Psychiatry. 2022;93(1):14–23. doi:10.1136/jnnp-2021-326571.
Stulberg EL, Sachdev PS, Murray AM, et al. Post-stroke brain health monitoring and optimization: a narrative review. J Clin Med. 2023;12(23):7413. doi:10.3390/jcm12237413.