Prevalence of Post-stroke Cognitive Impairment and Dementia in a Sudanese Cohort: A Single-center Retrospective Study

Abstract

Background: Post-stroke cognitive impairment (PSCI) and dementia are major contributors to disability worldwide. However, data from low- and middle-income countries (LMICs), including Sudan, remain limited. This study aimed to determine the prevalence of PSCI and dementia among Sudanese stroke survivors and identify associated risk factors. Methods: A hospital-based study was conducted at Al-Nou Hospital in Omdurman, Sudan. We adopted a cross-sectional design rather than a purely retrospective one. Eighty-one patients with a prior stroke diagnosis were recruited via purposive sampling (initially targeting 93 based on estimated stroke mortality but adjusted due to local constraints). A structured questionnaire and review of hospital records were used to collect demographic and clinical data; the Montreal Cognitive Assessment (MoCA) was used for cognitive evaluation. Descriptive statistics were obtained for all variables. Bivariate analyses (chi-square or Fisher-Freeman-Halton exact tests, depending on assumptions) and ordinal logistic regression were used to examine associations with four-level MoCA outcomes. Results: Of 81 stroke survivors (mean age 61.9±13.9 years), 72.8% had ischemic stroke, and 27.2% had hemorrhagic stroke. Hypertension (61.2%) and diabetes mellitus (36.2%) were the most common comorbidities. Right-hemisphere strokes were more frequent (64.2%) than left-hemisphere events (35.8%). In a four-level MoCA analysis, sex (female) and higher education were significantly associated with better cognitive outcomes (p<0.05). Comorbidity categories approached significance (p=0.075; exact p=0.063). Ordinal logistic regression confirmed higher education as an independent predictor of improved cognitive status (adjusted OR=4.07, p=0.018). Conclusion: PSCI was highly prevalent in this Sudanese stroke cohort, underscoring the need for systematic cognitive screening and aggressive management of vascular risk factors, particularly hypertension. Higher education and female sex were associated with better cognitive outcomes.