Longitudinal cognitive and functional outcomes after hemorrhagic stroke in patients with preserved consciousness: a prospective observational study

Introduction Cognitive impairment is a common consequence of stroke but may be underrecognized in patients with preserved consciousness. This study evaluated longitudinal changes in neurological, cognitive, and functional outcomes during the first 6 months after hemorrhagic stroke and identified baseline predictors of unfavorable outcomes. Methods A total of 74 patients with hemorrhagic stroke and preserved consciousness [Glasgow Coma Scale ≥13; mean age, 57.9 ± 10.1 years: 36 women (48.6%)] were prospectively enrolled between July 2020 and July 2024. Cognitive and functional outcomes were assessed at the initial assessment and at 1, 3, and 6 months using the Montreal Cognitive Assessment (MoCA), Clinical Dementia Rating (CDR), Basic Activities of Daily Living (BADL), and Instrumental Activities of Daily Living (IADL). Longitudinal changes were analyzed using linear mixed-effects models, and logistic regression was performed to identify predictors of unfavorable outcomes at 6 months. Results Cognitive measures improved significantly over time, with increases in MoCA scores ( p < 0.001) and reductions in CDR scores ( p = 0.028). In contrast, BADL and IADL showed trends toward improvement without statistical significance. At 6 months, 25.7% of patients had unfavorable cognitive or functional outcomes. Older age, lower educational level, and previous stroke were independently associated with unfavorable outcomes. Conclusion Patients with hemorrhagic stroke and preserved consciousness showed gradual cognitive improvement over 6 months, although a substantial proportion experienced unfavorable cognitive or functional outcomes. These findings highlight the potential importance of early cognitive assessment even in patients with relatively mild neurological presentations. Given the modest sample size and exploratory nature of the analyses, larger prospective studies are warranted to validate these findings and further investigate predictors of post-stroke cognitive and functional recovery.