Cognitive Trajectories of Post-Stroke Delirium: Longitudinal Global and Domain-Specific Impairment and…

Abstract

BackgroundPoststroke cognitive impairment (PSCI) and poststroke delirium (PSD) remain underexplored. Longitudinal assessments of cognition before PSD onset and at follow-up are scarce, leaving the association between PSD and subsequent global and domain-specific PSCI unclear. Digital assessments using task-derived kinematic parameters may provide complementary insights into cognitive vulnerability and PSD risk.

MethodsIn this prospective longitudinal study, patients with acute stroke underwent multidomain tablet-based neuropsychological assessment within the acute phase, before PSD onset, and at 90 days post-stroke. Global PSCI (gPSCI) and domain-specific PSCI (attention and processing speed, executive functions, verbal memory, language, and visuospatial-construction) were assessed using norm-referenced cognitive performance. Cognitive outcomes were compared between patients with and without PSD at both time points. Functional outcome, mortality, and quality of life were assessed at 90 days. Exploratory random forest analyses evaluated the discriminatory ability of acute-phase task-derived kinematic parameters.

ResultsAmong 31 patients with stroke, 10 developed PSD, 18 served as controls, and 3 dropped out. At 90 days, patients with PSD had more severe gPSCI than controls (U=19.500, p<0.001), whereas the acute-phase difference was not significant (U=50.500, p=0.057). Domain-specific analyses revealed distinct temporal patterns of cognitive impairment. During the acute phase, patients with subsequent PSD, showed significantly more severe impairments in attention and processing speed (U=29.500; p=0.003) and visuospatial-construction (U=31.500; p=0.004). At 90 days, differences in attention and processing speed persisted (U=21.000, p <0.001) with additional significant differences in executive functions (U=38.500, p=0.012) and language (U=45.500, p=0.031). Kinematic parameters showed discriminatory performance comparable to gPSCI (78.89% versus 81.50%). At 90 days, PSD was also associated with worse functional outcome (U=31.500, p=0.004), higher mortality (p=0.037), and lower mental quality of life (p=0.021).

ConclusionsPSD is associated with more severe global PSCI at 90 days post-stroke and distinct temporal pattern of domain-specific PSCI. Task-derived kinematic parameters may complement conventional cognitive scores. Larger multicenter studies are needed to validate these findings.

Trial RegistrationClinicalTrials.gov: NCT06680336. https://clinicaltrials.gov/study/NCT06680336

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BibTeX RIS

BibTeX

@misc{geiger2026cognitive,
  title = {{Cognitive Trajectories of Post-Stroke Delirium: Longitudinal Global and Domain-Specific Impairment and Digital Markers}},
  author = {L. S. Geiger and F. Wortha and S. Klütz and C. Mychiajliw and C. Gäbele and A. Jooss and S. Kindzierski and J. Sartor-Pfeiffer and C. Single and U. Ziemann and A. Mengel},
  howpublished = {medRxiv},
  year = {2026},
  month = oct,
  doi = {10.64898/2026.10.21.26366183},
  url = {https://www.medrxiv.org/content/10.64898/2026.10.21.26366183v1},
  note = {CC BY-NC-ND},
}

RIS

TY  - UNPB
TI  - Cognitive Trajectories of Post-Stroke Delirium: Longitudinal Global and Domain-Specific Impairment and Digital Markers
AU  - L. S. Geiger
AU  - F. Wortha
AU  - S. Klütz
AU  - C. Mychiajliw
AU  - C. Gäbele
AU  - A. Jooss
AU  - S. Kindzierski
AU  - J. Sartor-Pfeiffer
AU  - C. Single
AU  - U. Ziemann
AU  - A. Mengel
PY  - 2026
DA  - 2026/10/21
PB  - medRxiv
DO  - 10.64898/2026.10.21.26366183
UR  - https://www.medrxiv.org/content/10.64898/2026.10.21.26366183v1
AB  - BackgroundPoststroke cognitive impairment (PSCI) and poststroke delirium (PSD) remain underexplored. Longitudinal assessments of cognition before PSD onset and at follow-up are scarce, leaving the association between PSD and subsequent global and domain-specific PSCI unclear. Digital assessments using task-derived kinematic parameters may provide complementary insights into cognitive vulnerability and PSD risk.  MethodsIn this prospective longitudinal study, patients with acute stroke underwent multidomain tablet-based neuropsychological assessment within the acute phase, before PSD onset, and at 90 days post-stroke. Global PSCI (gPSCI) and domain-specific PSCI (attention and processing speed, executive functions, verbal memory, language, and visuospatial-construction) were assessed using norm-referenced cognitive performance. Cognitive outcomes were compared between patients with and without PSD at both time points. Functional outcome, mortality, and quality of life were assessed at 90 days. Exploratory random forest analyses evaluated the discriminatory ability of acute-phase task-derived kinematic parameters.  ResultsAmong 31 patients with stroke, 10 developed PSD, 18 served as controls, and 3 dropped out. At 90 days, patients with PSD had more severe gPSCI than controls (U=19.500, p<0.001), whereas the acute-phase difference was not significant (U=50.500, p=0.057). Domain-specific analyses revealed distinct temporal patterns of cognitive impairment. During the acute phase, patients with subsequent PSD, showed significantly more severe impairments in attention and processing speed (U=29.500; p=0.003) and visuospatial-construction (U=31.500; p=0.004). At 90 days, differences in attention and processing speed persisted (U=21.000, p <0.001) with additional significant differences in executive functions (U=38.500, p=0.012) and language (U=45.500, p=0.031). Kinematic parameters showed discriminatory performance comparable to gPSCI (78.89% versus 81.50%). At 90 days, PSD was also associated with worse functional outcome (U=31.500, p=0.004), higher mortality (p=0.037), and lower mental quality of life (p=0.021).  ConclusionsPSD is associated with more severe global PSCI at 90 days post-stroke and distinct temporal pattern of domain-specific PSCI. Task-derived kinematic parameters may complement conventional cognitive scores. Larger multicenter studies are needed to validate these findings.  Trial RegistrationClinicalTrials.gov: NCT06680336. https://clinicaltrials.gov/study/NCT06680336
ER  -

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