ORIGINAL COMMUNICATION Domain-specific trends in cognitive impairment after acute ischaemic stroke Robert Hurford • Andreas Charidimou • Zoe Fox • Lisa Cipolotti • David J. Werring Received: 24 April 2012 / Revised: 12 July 2012 / Accepted: 13 July 2012 / Published online: 3 August 2012 Ó Springer-Verlag 2012 Abstract Little is known about the pattern of subacute cognitive domain impairments after ischaemic stroke, nor the temporal evolution of such impairments. Our objective was to investigate the pattern of cognitive impairment in different neuropsychological domains up to a year after ischaemic stroke. We included prospectively collected data from an observational database of stroke patients at the National Hospital for Neurology and Neurosurgery, Queen Square, London, UK. Patients were categorised into tem- poral groups according to the time between the index stroke and neuropsychological profiling. The prevalence of impairment in different cognitive domains was then com- pared between these categories. The final cohort consisted of 209 patients. Frontal executive function, perceptual and nominal skills all showed a strong trend, with levels of impairment of approximately 30 % at \ 1 month and less than half this at [ 3 months (p \ 0.05). Speed and attention was the most impaired domain, but had the greatest trend for decreasing impairment, from 72.4 % acutely to 37.9 % after 3 months (p \ 0.01). By contrast, we found that impairment in visual and verbal memory showed no sta- tistically significant change over time. Our results suggest a domain-specific improvement in cognition after ischaemic stroke. Early assessments may overestimate longer term cognitive deficits, particularly in speed and attention and perceptual functions. The domain-specific improvement patterns may help to inform long-term rehabilitation plans, which should not be based solely on cognitive assessments undertaken within the first month after stroke. Keywords Ischaemic stroke Á Post-stroke cognitive impairment Introduction Vascular cognitive impairment (including dementia) is a major increasing global public health challenge [1–3]. Dementia affects about one-third of stroke survivors at 1 year [4], but a larger proportion (around 60 %) has some degree of cognitive decline, not fulfilling established cri- teria for dementia [5]. Less attention has been paid to patients with post-stroke cognitive impairment without dementia, although such patients have significant func- tional limitations and are at high risk of progression to dementia, which might be preventable [6]. Many studies in post-stroke cognitive function used global screening instruments including the Mini-Mental State Examination (MMSE), which has been criticised for its insensitivity to focal cognitive deficits [7, 8]. Therefore little is known about the detailed pattern of cognitive Electronic supplementary material The online version of this article (doi:10.1007/s00415-012-6625-0) contains supplementary material, which is available to authorized users. R. Hurford Á A. Charidimou Á D. J. Werring Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK R. Hurford Á A. Charidimou Á D. J. Werring (&) The National Hospital for Neurology and Neurosurgery, Box 6, Queen Square, London WC1N 3BG, UK e-mail: d.werring@ucl.ac.uk Z. Fox Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK L. Cipolotti Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK 123 J Neurol (2013) 260:237–241 DOI 10.1007/s00415-012-6625-0