Cognitive Recovery After Poststroke Delirium (RECOVER): Protocol for a Longitudinal Multimodal Study on Cognitive Assessment in Patients With Stroke
Bibliographic record
Abstract
Background: Poststroke delirium (PSD) is a severe complication in patients with acute stroke and is characterized by rapid onset fluctuating symptoms, which affect multiple domains (cognition, motor system, and sleep-wake cycle). Similar to other types of delirium, PSD is associated with longer hospitalization, higher mortality, and a higher disability rate. Behavioral studies on cognitive functioning showed significantly poorer cognitive outcomes in both patients with and without PSD compared to healthy controls. Thus, the distinction between "stroke-related" and "PSD-related" cognitive impairments remains unclear. A frequently affected and highly disabling cognitive domain is memory function. However, imaging studies, particularly task-based functional magnetic resonance imaging (MRI) studies on PSD, are currently scarce and represent a significant gap in the existing literature. Objective: This longitudinal proof-of-concept study aims to investigate the short- and long-term effects of stroke and PSD on cognitive outcome using a multimodal approach and to outline a protocol for a repeated multimodal cognitive assessment in patients with stroke. Methods: We developed a longitudinal study protocol to investigate short- and long-term effects of stroke and PSD on cognitive impairment and recovery. Poststroke cognitive impairment (PSCI) will be assessed in a comprehensive digital multimodal approach including a multidomain neuropsychological app to facilitate a standardized, rapid testing, particularly for long-term outcomes, as well as task-based functional MRI (introducing a modified working memory task) during the acute (prior PSD development) and postacute phase post stroke and at a 3-month follow-up. In total, 40 patients with acute stroke, divided into a PSD group and non-PSD group (control), will be examined. In the context of the proof-of-concept study, the eligibility of a modified working-memory task, an app-based neuropsychological assessment, and a multimodal MRI protocol will be evaluated. The primary endpoint is a between-group comparison of the cognitive outcome, defined as global PSCI at a 3-month follow-up. Global PSCI will be classified as normal cognitive functioning, or mild, moderate, or severe cognitive impairment, according to the performance level (norm-referenced z scores) on a multidomain neuropsychological assessment. Results: This study was funded in December 2023. As of May 2025, 15 patients with stroke have been included. Recruitment and data collection were initiated in June 2024 and are ongoing until December 2025. The findings are expected to be published in summer 2026. Conclusions: This protocol outlines a proof-of-concept study aiming to fill a critical gap by systematically investigating cognitive functions in patients with acute stroke with and without delirium. Generating reliable preliminary data will provide essential groundwork for future large-scale research, ultimately enhancing understanding of the contribution of PSD to cognitive impairment.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.026 | 0.015 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.004 | 0.004 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.005 | 0.002 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.003 | 0.004 |
| Insufficient payload (model declined to judge) | 0.013 | 0.005 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".