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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Association Between Daily Energy Intake and Cognitive Recovery After Mechanical Thrombectomy for Acute Ischemic Stroke: A Multicenter Retrospective Study

  • Sergiu Florin Arnăutu1,2,3
  • Diana Aurora Arnăutu2,4
  • Tufail Patankar3
  • Mohd Shariq3
  • Hamood Qazi5
  • Martin Lewis3
  • Sara Sciacca6
  • Dragoș Cătălin Jianu1,7,8
  • Octavian M. Crețu9
  • Dorel Sandesc10
  • Claudiu-Daniel Malița11
  • Cătălin Juratu12,13
2 more authors
  • Brenda-Cristiana Bernad13,14,15
  • Jeremy Lynch3,6
15 affiliations
  1. 1Centre for Cognitive Research in Neuropsychiatric Pathology (Neuro-Psy-Cog), Department of Neurosciences, “Victor Babes” University of Medicine and Pharmacy from Timisoara, E. Murgu Sq., No. 2, 300041 Timisoara, Romania
  2. 2Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy from Timisoara, E. Murgu Sq., No. 2, 300041 Timisoara, Romania
  3. 3Department of Interventional Neuroradiology, Queen’s Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, London RM7 0AG, UK
  4. 4Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds LS2 9JT, UK
  5. 5Department of Stroke Medicine, Queen’s Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, London RM7 0AG, UK
  6. 6Department of Neurosciences, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
  7. 7First Division of Neurology, Department of Neurosciences, “Victor Babes” University of Medicine and Pharmacy from Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania
  8. 8Department of Neurology I, Pius Brînzeu County Clinical Emergency Hospital, 156 L. Rebreanu Ave., 300723 Timisoara, Romania
  9. 9First Department of Surgery—Clinic of Surgical Semiotics and Thoracic Surgery, Centre for Hepato-Biliary and Pancreatic Surgery, “Victor Babes” University of Medicine and Pharmacy from Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania
  10. 10Department of Anesthesia and Intensive Care, “Victor Babes” University of Medicine and Pharmacy from Timisoara, E. Murgu Sq., No. 2, 300041 Timisoara, Romania
  11. 11Department of Radiology, “Victor Babes” University of Medicine and Pharmacy from Timisoara, E. Murgu Sq., No. 2, 300041 Timisoara, Romania
  12. 12Department of Interventional Radiology, Pius Brînzeu County Clinical Emergency Hospital, 156 L. Rebreanu Ave., 300723 Timisoara, Romania
  13. 13Doctoral School, “Victor Babes” University of Medicine and Pharmacy from Timisoara, E. Murgu Sq., No. 2, 300041 Timisoara, Romania
  14. 14Department of Neuroscience, “Victor Babes” University of Medicine and Pharmacy from Timisoara, E. Murgu Sq., No. 2, 300041 Timisoara, Romania
  15. 15Centre for Neuropsychology and Behavioural Medicine, “Victor Babes” University of Medicine and Pharmacy from Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania
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Abstract

Background: Post-stroke cognitive impairment is a common complication associated with reduced functional independence and quality of life. Although adequate daily energy intake is considered an essential component of stroke rehabilitation, its association with cognitive recovery after mechanical thrombectomy remains poorly understood. This study investigated the relationship between daily energy intake and 90-day cognitive outcomes in patients with acute ischemic stroke treated with mechanical thrombectomy. Methods: This multicenter retrospective observational cohort study included 100 consecutive patients undergoing mechanical thrombectomy between 1 April 2025 and 1 April 2026 at stroke centers in the United Kingdom and Romania. Daily energy and macronutrient intake were retrospectively extracted from routine clinical records and normalized to body weight (kcal/kg/day). Daily energy intake was evaluated primarily as a continuous exposure (kcal/kg/day), while the originally defined 31 kcal/kg/day grouping was retained for exploratory categorical analyses. Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA) at baseline and, among survivors with available cognitive follow-up, at 90 days. The primary multivariable model evaluated daily energy intake (kcal/kg/day) as a continuous exposure and adjusted for baseline MoCA, atrial fibrillation, chronic coronary artery disease, admission NIHSS, C-reactive protein, and PICA/AICA/SCA occlusion. HC3 heteroscedasticity-consistent standard errors were used for robust inference. Results: Among patients with available 90-day cognitive assessment, those with higher energy intake achieved significantly higher 90-day MoCA scores than those with lower intake (24.2 ± 2.1 vs. 20.0 ± 1.5; p < 0.001) and greater cognitive improvement (ΔMoCA: 3.82 ± 1.08 vs. 0.48 ± 0.54 points; p < 0.001). In the primary continuous-exposure model, each additional 1 kcal/kg/day was associated with a 0.18-point higher 90-day MoCA score after multivariable adjustment (β = 0.179, HC3 95% CI 0.081–0.278; p < 0.001). The association remained similar in an expanded sensitivity model addressing available indicators of baseline severity (β = 0.176, HC3 95% CI 0.071–0.281; p = 0.002). Exploratory categorical analyses also showed higher 90-day MoCA scores in the higher-intake group. No significant differences were observed in NIHSS or mRS at 90 days. Conclusions: Higher daily energy intake was associated with higher 90-day cognitive performance among survivors with available cognitive follow-up after mechanical thrombectomy. Given the retrospective observational design, baseline differences between exposure groups, and potential residual confounding and reverse causality, these findings should be considered exploratory and hypothesis-generating. Prospective studies are required to determine whether nutritional optimization can influence cognitive recovery after stroke.

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Cite

BibTeXRIS
BibTeX
@article{arnautu2026association,
  title = {{Association Between Daily Energy Intake and Cognitive Recovery After Mechanical Thrombectomy for Acute Ischemic Stroke: A Multicenter Retrospective Study}},
  author = {Sergiu Florin Arnăutu and Diana Aurora Arnăutu and Tufail Patankar and Mohd Shariq and Hamood Qazi and Martin Lewis and Sara Sciacca and Dragoș Cătălin Jianu and Octavian M. Crețu and Dorel Sandesc and Claudiu-Daniel Malița and Cătălin Juratu and Brenda-Cristiana Bernad and Jeremy Lynch},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = oct,
  doi = {10.3390/jcm15218333},
  url = {https://www.mdpi.com/2077-0383/15/21/8333},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Association Between Daily Energy Intake and Cognitive Recovery After Mechanical Thrombectomy for Acute Ischemic Stroke: A Multicenter Retrospective Study
AU  - Sergiu Florin Arnăutu
AU  - Diana Aurora Arnăutu
AU  - Tufail Patankar
AU  - Mohd Shariq
AU  - Hamood Qazi
AU  - Martin Lewis
AU  - Sara Sciacca
AU  - Dragoș Cătălin Jianu
AU  - Octavian M. Crețu
AU  - Dorel Sandesc
AU  - Claudiu-Daniel Malița
AU  - Cătălin Juratu
AU  - Brenda-Cristiana Bernad
AU  - Jeremy Lynch
PY  - 2026
DA  - 2026/10/26
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15218333
UR  - https://www.mdpi.com/2077-0383/15/21/8333
AB  - Background: Post-stroke cognitive impairment is a common complication associated with reduced functional independence and quality of life. Although adequate daily energy intake is considered an essential component of stroke rehabilitation, its association with cognitive recovery after mechanical thrombectomy remains poorly understood. This study investigated the relationship between daily energy intake and 90-day cognitive outcomes in patients with acute ischemic stroke treated with mechanical thrombectomy. Methods: This multicenter retrospective observational cohort study included 100 consecutive patients undergoing mechanical thrombectomy between 1 April 2025 and 1 April 2026 at stroke centers in the United Kingdom and Romania. Daily energy and macronutrient intake were retrospectively extracted from routine clinical records and normalized to body weight (kcal/kg/day). Daily energy intake was evaluated primarily as a continuous exposure (kcal/kg/day), while the originally defined 31 kcal/kg/day grouping was retained for exploratory categorical analyses. Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA) at baseline and, among survivors with available cognitive follow-up, at 90 days. The primary multivariable model evaluated daily energy intake (kcal/kg/day) as a continuous exposure and adjusted for baseline MoCA, atrial fibrillation, chronic coronary artery disease, admission NIHSS, C-reactive protein, and PICA/AICA/SCA occlusion. HC3 heteroscedasticity-consistent standard errors were used for robust inference. Results: Among patients with available 90-day cognitive assessment, those with higher energy intake achieved significantly higher 90-day MoCA scores than those with lower intake (24.2 ± 2.1 vs. 20.0 ± 1.5; p < 0.001) and greater cognitive improvement (ΔMoCA: 3.82 ± 1.08 vs. 0.48 ± 0.54 points; p < 0.001). In the primary continuous-exposure model, each additional 1 kcal/kg/day was associated with a 0.18-point higher 90-day MoCA score after multivariable adjustment (β = 0.179, HC3 95% CI 0.081–0.278; p < 0.001). The association remained similar in an expanded sensitivity model addressing available indicators of baseline severity (β = 0.176, HC3 95% CI 0.071–0.281; p = 0.002). Exploratory categorical analyses also showed higher 90-day MoCA scores in the higher-intake group. No significant differences were observed in NIHSS or mRS at 90 days. Conclusions: Higher daily energy intake was associated with higher 90-day cognitive performance among survivors with available cognitive follow-up after mechanical thrombectomy. Given the retrospective observational design, baseline differences between exposure groups, and potential residual confounding and reverse causality, these findings should be considered exploratory and hypothesis-generating. Prospective studies are required to determine whether nutritional optimization can influence cognitive recovery after stroke.
SN  - 2077-0383
ER  -