Cognitive function is dynamic in post-stroke patients, however, there are limited studies on cognitive recovery after stroke. The definition of cognitive reverters and neuropsychological characteristics according to various definitions have not yet been investigated.

To investigate the neuropsychological characteristics of cognitive reverters after stroke based on the traditional definition and new definition according to Montreal Cognitive Assessment (MoCA) with a double threshold.

A total of 163 patients hospitalized for first onset acute ischemic stroke were recruited from the Department of Neurology of the Second Hospital of Hebei Medical University from December 2020 to February 2022 as the study subjects. All patients were assessed for cognitive function in the acute period of ischemic stroke using the MoCA at baseline. Cognitive function was assessed again at the 6-month post-stroke follow-up with the detailed neuropsychological tests refined at the same time, including the digit span task (DST) , Stroop color and word test (SCWT) , Chinese version of Boston naming test (BNT) , verbal fluency test (VFT) , clock drawing test (CDT) , and auditory verbal learning test (AVLT) . The enrolled patients were divided into the M1 group (MoCA scores <21) , M2 group (21 ≤MoCA scores≤25) and M3 group (MoCA scores≥26) according to the MoCA with adouble threshold. While the patients were also divided into the reverters 1 (R1) group, nonreverters 1 (NR1) group, R2 group and NR2 group according to the two definitions of reverters.

Patients were followed up after 6 months, of which 28 were lost to follow-up and 135 were finally included in the study. The average MoCA score in the acute period of stroke was (20.1±5.1) in 135 patients. There were 40 cases in the M1 group, 61 cases in the M2 group and 34 cases in the M3 group. The scores of the MoCA, forward DST, reverse DST, total DST, Chinese version of BNT, CDT, numbers of VFT-animal, VFT-fruit and VFT-vegetable, AVLT-immediate scores, AVLT-short delay scores, AVLT-long delay scores and AVLT-recognition scores in the M2 and M3 groups 6 months after stroke were higher than the M1 group (P<0.05) , Stroop C time consuming and numbers of Stroop C errors lower than M1 group (P<0.05) . The scores of the MoCA, reverse DST, total DST, AVLT-short delay score and AVLT-long delay score in the M3 group than the M2 group (P<0.05) . 120 patients of the 135 patients with MoCA scores<26 in the acute period of ischemic stroke were selected as the cognitive reveters study subjects. Compared with the MoCA scores during the acute period of ischemic stroke, 73 patients improved ≥2 points during the follow-up period in the R1 group and 47 patients improved <2 points in the NR1 group, with a recovery rate of 60.8% (73/120) . Patients in the R1 group had lower MoCA scores in the acute period of ischemic stroke than the NR1 group, and higher MoCA scores in the follow-up period than the NR1 group (P< 0.05) . Compared with the double threshold classification of MoCA in the acute period of stroke, 50 cases had increased scores and crossed over to the R2 group and 70 cases did not cross over to the NR2 group at follow-up, with a recovery rate of 41.7% (50/120) . Patients in the R2 group had higher MoCA score in the acute period of stroke, MoCA scores in the follold-up period, reverse DST scores, total DST scores, Chinese version of BNT scores, VFT-animal, VFT-vegetable number, CDT scores, AVLT-immediate scores, AVLT-short delay scores, AVLT-long delay scores, and AVLT-recognition scores during follow-up were higher than the NR2 group, and the Stroop C time consuming was lower than the NR2 group (P<0.05) .

There are varying degrees of impairment in attention, visuospatial function and delayed recall in post-stroke patients. There is no significant difference in neuropsychological characteristics between reverters and nonreverters. However, the scores of reverters are higher based on the definition using double threshold for MoCA scores, which is more relevant for clinical use.