Long-term social cognitive impairment after ischemic stroke: Frequency and association with lesion volume and...

Social cognition, with emotion recognition (ER) being a key component, is recognized as a core cognitive domain, yet research on ER post-stroke remains limited. This exploratory pilot study aimed to provide preliminary estimates of long-term ER impairment after stroke and to examine its association with lesion volume and location.

We invited patients <65 years, admitted for endovascular treatment (EVT) and included in a prospective cohort; the Oslo Acute Reperfusion Stroke Study, to participate in a 4-year follow-up study, and a healthy control (HC) group. ER was assessed using the "Pictures of Facial Affect" (PFA) test, impairment defined as performance ≥1.5 SD below HC mean. Linear regression analysis examined relationship between baseline predictors and ER at follow-up. Voxel-based lesion-symptom mapping (VLSM) were used to identify brain regions associated with ER, complemented by disconnectome mapping.

Of 109 participants included, 40 completed a 4-year follow-up including the PFA test (24 (60%) women, mean age 51 (SD ± 10) years). ER impairment was detected in 9 (23%) patients. Stroke lesion volume was significantly associated with PFA scores in both univariable and multivariable analysis, adjusted for sex, education, and time to recanalization. VLSM revealed associations between right-hemisphere cortical regions and lower PFA scores, notably the inferior parietal lobule and and adjacent perisylvian cortex.

Emotion recognition impairment was identified in more than one in five stroke patients four years after EVT. These preliminary findings identify stroke lesion burden and location as candidate group-level prognostic markers that warrant confirmation in larger studies of this under-researched cognitive domain.