Determinants of Post-Stroke Cognitive Impairment in a Hospital-Based Sialkot Cohort

Abstract

Background: Post-stroke cognitive impairment (PSCI) is one of the most disabling sequelae of stroke, contributing to functional dependence, poor rehabilitation outcomes, and reduced quality of life. Despite a rising burden of stroke in Pakistan, there remains limited evidence on the prevalence and determinants of PSCI in secondary-care hospital settings. Objective: To assess the frequency and predictors of post-stroke cognitive impairment among survivors in Sialkot hospitals and to identify the independent socio-demographic and clinical factors influencing cognitive outcomes. Methods: An analytical cross-sectional study was conducted among 100 stroke survivors and 100 healthy controls recruited from four major hospitals in Sialkot between January and June 2024. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), stroke severity by the National Institutes of Health Stroke Scale (NIHSS), and functional status by the Barthel Index. Data were analyzed using SPSS v25, applying t-tests, ANOVA, correlation, and multiple linear regression to determine independent predictors of MoCA scores. Results: Cognitive impairment (MoCA <26) was observed in 78% of stroke survivors versus 12% of controls (p<0.001). Lower MoCA scores correlated significantly with older age (r=-0.47), higher NIHSS (r=-0.59), and lower Barthel Index (r=+0.63). Education, stroke severity, and functional independence independently predicted cognitive performance (adjusted R²=0.61). Conclusion: Post-stroke cognitive impairment is highly prevalent among stroke survivors in Sialkot and is primarily influenced by age, education, and neurological severity. Routine cognitive screening and integrated rehabilitation strategies are recommended to enhance recovery and independence.