ABSTRACT NUMBER: ESOC2026A2131 DIGITAL COGNITIVE ASSESSMENT AFTER MCA STROKE: FINDINGS FROM A PROSPECTIVE COHORT STUDY IN SEVERELY AFFECTED STROKE PATIENTS

Abstract Background and aims Cognitive impairment is a common consequence of middle cerebral artery (MCA) strokes, particularly in patients with large-vessel occlusion (LVO) and moderate to severe disability. Due to motor or language deficits these patients are often unable to participate in neuropsychological testing, leading to their underrepresentation in research and unknown cognitive trajectories. This prospective longitudinal study investigates whether digital cognitive testing enables effective, meaningful, and repeated neurocognitive assessment in severely affected stroke patients during the acute and chronic post-stroke phases. Methods This ongoing monocentric prospective longitudinal study enrolls acute ischemic stroke patients with right- or left-sided MCA occlusion (M1–M3) and an initial modified Rankin Scale (mRS) score ≥3. Cognitive assessment is performed at 5 days (V2), 90 days (V3), and 180 days (V4) post-stroke using a multi-domain digital neuropsychological evaluation (TuCAN App). The primary endpoint is the comparison of cognitive outcomes between V2 and V3 in patients with successful versus unsuccessful recanalization. Secondary analyses explore hemispheric differences and longitudinal cognitive changes. Results To date, 52 patients have been enrolled; 52 completed acute assessment (V2), 23 completed the 90-day follow-up (V3). Digital assessment was well tolerated, with high task completion. Importantly, the assessments yielded interpretable and longitudinally comparable cognitive profiles, enabling meaningful evaluation of neurocognitive function. Conclusions Digital cognitive assessment provides an effective and informative approach to longitudinally evaluate cognition in severely disabled MCA stroke patients. This strategy allows systematic neurocognitive follow-up in a patient group that is largely excluded from conventional post-stroke cognitive research and clinical assessment. Conflict of interest Lena S. Geiger: nothing ot disclose, Valeria Inglese: nothing to disclose, Michael Mychajliw: nothing to disclose, Christoph Gäbele: nothing to disclose, Katharina Feil: nothing to disclose, Annerose Mengel: nothing to disclose; Annerose Mengel and Katharina Feil contributed equally to this work