Abstract Body:
Background: Post-stroke cognitive impairment is especially devastating for young adult patients, who are in their most productive years. Despite its significant impact, this remains under-studied in this growing and clinically distinct patient group.

Methods: We systematically searched PubMed, Embase, Scopus, and Cochrane CENTRAL for studies including ischemic stroke patients aged 18-50 years from January 2000 to July 2024. This meta-analysis evaluated the pooled prevalence of post-stroke cognitive impairment (CogI) and specific cognitive domains, as well as the associations between baseline characteristics and CogI.

Results: A total of 4 studies with 1060 patients were included in this systematic review and meta-analysis. Overall, 35.9% (95% CI 27.2-45.5; Figure 1) of patients experienced post-stroke CogI with a mean follow-up time of 11.7 months (95% CI 8.00-15.4). One study was not included in the meta-analysis of proportions of overall cognition as this information was not available. The prevalence for individual domains was: visuospatial construction (23.1%; 95% CI 14.7-34.4), episodic memory (18.5%; 95% CI 9.7- 32.5), delayed memory (16.0%; 95% CI 13.5-18.9), working memory (18.8%; 95%CI 11.8-28.6), and attention (9.3%; 95%CI 3.2-24.0) with a mean follow-up time of 8.11 months (95% CI 3.50-12.7). Male patients had significantly higher odds of CogI (OR 1.58, 95% CI 1.05-2.38, p=0.030; Figure 2). Hypertension, diabetes mellitus, current smoking and dyslipidaemia were not significantly associated with CogI.

Conclusions: A significant proportion of young adult ischemic stroke survivors experience CogI. Longitudinal prospective cohort studies are needed to better characterise the post-stroke cognitive trajectory in this important group of patients.