Anterior Versus Posterior Circulation Acute Ischemic Stroke and 3-Month Cognitive Profiles: A Single-Center Cohort Study

Post-stroke cognitive impairment (PSCI) is common, but its pattern may differ between vascular territories. This single-center cohort included adults with first-ever, magnetic resonance imaging (MRI)-confirmed acute ischemic stroke admitted between May 2022 and June 2024. Infarcts were classified as anterior or posterior circulation, and cognition was assessed in person at 3 months using the Beijing version of the Montreal Cognitive Assessment (MoCA). The primary PSCI definition was an education-adjusted MoCA score <26, with a sensitivity analysis using <22. Of 173 enrolled patients, 167 completed follow-up (91 anterior and 76 posterior circulation infarctions). PSCI occurred in 50/91 (54.9%) and 27/76 (35.5%) patients, respectively (p = 0.012). The unadjusted odds ratio was 2.21 (95% confidence interval, 1.18-4.14), and the adjusted odds ratio was 2.18 (95% confidence interval, 1.06-4.49; p = 0.035). With the <22 cutoff, the corresponding prevalences were 31.9% and 15.8%, and the adjusted odds ratio was 2.43 (95% confidence interval, 1.06-5.54; p = 0.035). After false-discovery-rate correction, differences in visuospatial/executive, naming, delayed-recall, language, abstraction, and orientation performance remained, whereas attention did not differ. Cognitive outcomes differed between vascular-territory groups despite similar global disability scores; these group-level associations do not establish a causal effect of territory or a domain-specific diagnosis.