Cognitive outcomes of pediatric stroke
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Updated: Mar 10, 2026
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Published on: June 6, 2025
Isabella Jacomb1, Melanie Porter1, Ruth Brunsdon2
1a Department of Psychology , Macquarie University , North Ryde , Australia.
Insights
Children with stroke experience long-term cognitive deficits, particularly in attention and academic skills, which remain stable over time. Younger age at stroke is linked to poorer intellectual functioning, supporting the early vulnerability hypothesis.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Cognitive Psychology
Background:
- Longitudinal studies on pediatric stroke neuropsychological development are limited.
- Understanding long-term cognitive outcomes is crucial for this population.
- Previous research highlights the impact of stroke on developing brains.
Purpose of the Study:
- To retrospectively examine cognitive outcomes in children with a history of stroke.
- To investigate the influence of age at stroke, laterality, region, and mechanism on neuropsychological development.
- To assess changes in intellectual functioning, memory, executive functioning, attention, and academic skills over time.
Main Methods:
- Retrospective analysis of 41 children with a history of stroke.
- Neuropsychological assessments administered at two time points for intellectual functioning and memory.
- Single-time point assessments for executive functioning, attention, and academic skills.
- Comparison of performance against normative data.
Main Results:
- Children with stroke performed significantly worse than normative expectations across all assessed cognitive domains.
- Up to two-thirds of children exhibited borderline or impaired cognitive functioning in at least one area.
- Intellectual functioning and memory performance remained relatively stable over the study period.
- Younger age at stroke correlated with poorer intellectual functioning.
- No significant effects of stroke laterality on long-term neuropsychological performance were observed.
- Children with subcortical strokes showed greater improvement in immediate memory compared to those with cortical strokes.
Conclusions:
- Pediatric stroke survivors face persistent long-term cognitive challenges, notably in attention and academic skills.
- Cognitive difficulties tend to remain stable post-stroke.
- Early age at stroke is a significant predictor of poorer cognitive outcomes, supporting the 'early vulnerability' concept.
- Subcortical strokes may have a different trajectory for memory recovery compared to cortical strokes.
Abstract:
A limited number of longitudinal studies have investigated long-term neuropsychological development in the pediatric stroke population. This study retrospectively examines cognitive outcomes in 41 children with a history of stroke, with reference to age at stroke, laterality, region and mechanism of stroke. In the course of recovery, neuropsychological measures of intellectual functioning and memory were administered at two time points, whilst executive functioning, attention and academic skills were administered at one time point. As predicted, children with stroke performed significantly worse compared to normative expectations on all neuropsychological measures. Up to two thirds of children scored in the borderline impaired and impaired ranges on at least one domain of cognition. Performance on intellectual and memory assessment remained relatively stable over time. Younger age at stroke was found to be associated with poorer intellectual functioning. No effects of laterality of stroke on neuropsychological performance over time were found. Children with subcortical stroke demonstrated a greater improvement in immediate memory over time than children with cortical stroke. These findings reveal that children with stroke display long-term cognitive difficulties that typically remain stable over time. Attention and academic skills are particularly vulnerable to impairment. Further evidence that age at stroke is a significant factor in terms of cognitive outcome is provided, in support of the "early vulnerability" position.
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