Longitudinal trajectories of global and domain-specific cognition after stroke using the Oxford Cognitive Screen

BackgroundCognitive 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 [&ge;]2 years post-stroke and identify predictors of persistent impairment. MethodsParticipants were assessed acutely, at 6 months, and [&ge;]2 years post-stroke (Median = 4.1 years [IQR = 3.3]). The Oxford Cognitive Screen (OCS) was administered at all timepoints. Global impairment severity was quantified by the proportion of OCS subtasks impaired. Logistic mixed-effects models examined longitudinal change and predictors of domain-specific impairments (language, memory, attention, executive function, number processing). Latent class growth analysis (LCGA) identified distinct cognitive trajectories. ResultsOf 105 patients assessed, 98 had complete OCS data. Cognitive impairment severity improved substantially by 6 months ({beta} = -0.11) and further long term (>2 years; {beta} = -0.15). Acute impairment severity strongly predicted long-term outcomes ({beta} = 0.50; p < 0.001), while demographic and vascular factors explained minimal variance. LCGA identified four 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 (OR = 16.40) and language (OR = 8.17), more limited in attention (OR = 5.41) and executive function (OR = 4.14). Domain models revealed additional classes of persistent or delayed recovery, particularly in executive function and attention. ConclusionsCognitive 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.