Clinical, Neuroanatomical, and Multidomain Cognitive Profiles of Post-Stroke Cognitive Impairment at a Tertiary Referral Hospital in Bali, Indonesia: A Cross-Sectional Study

Background: Post-stroke cognitive impairment (PSCI) compromises functional recovery and independence, yet clinicoradiological and domain-specific profiles in Indonesia remain undercharacterized. Objective: To characterize the clinical, neuroanatomical, and multidomain cognitive profiles of PSCI and factors associated with moderate-to-severe PSCI at a tertiary referral hospital in Bali, Indonesia. Methods: This cross-sectional, record-based study enrolled 60 patients with PSCI by total consecutive sampling at the Neurology Polyclinic, Prof. Dr. I.G.N.G. Ngoerah General Hospital (January 2025–April 2026). Cognitive severity and domain deficits were assessed with the Indonesian Montreal Cognitive Assessment (MoCA-Ina). Univariate, bivariate, and multivariable logistic regression were used. Results: Mean age was 61.71 ± 11.53 years; 60.0% were male and 25.0% had recurrent stroke. Ischemic stroke predominated (68.3%); 51.7% were evaluated within < 1 year of onset and 85.0% had minor admission stroke severity (NIHSS 1–4). Subcortical lesions (95.0%), multiple lesion locations (63.3%), hypertension (80.0%), and multiple comorbidities (71.7%) predominated. Mild, moderate, and severe PSCI accounted for 43.3%, 26.7%, and 30.0% of cases (56.7% moderate-to-severe). Multidomain impairment occurred in 95.0%, affecting memory (95.0%), executive function (85.0%), language (81.7%), attention (75.0%), and visuospatial ability (46.7%). Multiple comorbidities (aOR = 16.92, p = 0.003), admission NIHSS ≥ 5 (aOR = 13.75, p = 0.044), recurrent stroke (aOR = 9.55, p = 0.018), and multiple lesion locations (aOR = 6.18, p = 0.014) were independently associated with moderate-to-severe PSCI (AUC = 0.860). Conclusion: PSCI was predominantly multidomain, affecting memory and executive function despite minor initial stroke severity, supporting early MoCA-Ina screening and targeted neurorehabilitation.