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

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.