Longitudinal Assessment of Executive and Visuospatial Function Recovery and Its Relationship with Functional Outcomes in Ischemic Stroke Patients

Background and Objectives: Cognitive impairments in the executive and visuospatial domains are common after ischemic stroke and significantly affect a patient’s independence. These impairments can affect problem-solving abilities, planning, decision-making, and spatial awareness, which are critical for functional recovery. Understanding the trajectory of recovery and its association with functional outcomes is essential for improving the quality of life of stroke survivors. The Objectives of the study are to evaluate the recovery patterns of executive and visuospatial functions 90 days after ischemic stroke and to examine their relationship with functional outcomes. Methods: In this longitudinal study, 401 patients with neuroimaging-confirmed ischemic stroke were assessed at admission and on Days 7, 30, and 90 post-stroke. Executive function was measured using the alternate Trail Making Test, and visuospatial function was assessed using the cube-copying and clock-drawing tests. Functional outcomes were evaluated using the modified Rankin Scale (mRS) and Barthel Index. Repeated measures ANOVA (analysis of variance) was employed to assess cognitive recovery over time, and Spearman’s correlation was used to examine the relationship between cognitive and functional outcomes. Results: Significant improvements in executive and visuospatial functions were observed over the 90-day period, with the greatest gains noted within the first 30 days. A moderate-to-strong negative correlation between mRS and cognitive function was identified at all time points, peaking on Day 7. Conclusions: Executive and visuospatial functions show dynamic recovery in the first 90 days post-stroke, particularly during the acute and subacute phases. Functional disability is closely associated with cognitive performance, underscoring the importance of early cognitive assessment.