Cognitive and Emotional Impairments in Acute Post-Stroke Patients—A Cross-Sectional Study

<i>Background and Objectives</i>: Stroke is widely recognised for its physical consequences. However, cognitive and emotional impairments, such as depression, anxiety, and vascular cognitive impairment (VCI), are often under-recognised and under-treated. Our study aimed to identify and characterise cognitive and emotional sequelae in patients hospitalised for acute ischemic stroke. <i>Materials and Methods</i>: We conducted a cross-sectional study involving 73 patients within seven days of an acute ischemic stroke. Patients were assessed using the National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), Montreal Cognitive Assessment (MoCA), Hachinski Ischemic Score (HIS), and the Clinical Assessment of Depression (CAD) questionnaire, which includes four subscales (Depressed Mood (DM), Anxiety/Worry, Disinterest, and Physical Fatigue). K-means clustering was applied to ten standardised clinical and psychometric variables. In addition, multiple linear regression was performed to determine independent predictors of cognitive and affective outcomes, with MoCA and CAD-DM as dependent variables. <i>Results</i>: Three distinct patient profiles emerged: (1) Mild Impairment Profile, characterised by minimal cognitive or emotional symptoms; (2) Depressive Profile, marked by elevated emotional symptom scores despite mild physical impairment; and (3) Vascular Cognitive Impairment Profile, comprising older patients with the most severe cognitive and functional deficits. ANOVA confirmed significant differences between groups in NIHSS, mRS, MoCA, HIS, and CAD scores, but not for age or education. Linear regression revealed that older age (β = -0.10, <i>p</i> = 0.012) and higher NIHSS at discharge (β = -0.72, <i>p</i> = 0.020) predicted lower MoCA scores, whereas years of education (β = 0.58, <i>p</i> = 0.013) predicted better cognition (R² = 0.29). No demographic or clinical factors predicted depressive symptoms (all <i>p</i> > 0.29). <i>Conclusions</i>: Our study highlights the heterogeneity of post-stroke outcomes. Neuropsychiatric impairments may be present even in patients with minimal physical deficits and require targeted evaluation and management.