Neurovascular coupling assessment by transcranial doppler in acute stroke could be informative of long-term cognitive status.

To assess whether Neurovascular Coupling (NVC) status in acute ischemic stroke predicts long-term cognitive impairment, this prospective study included consecutive ischemic stroke patients, without prior cognitive deficits, recruited between September 2021 and August 2022. Transcranial Doppler (TCD) monitoring was performed within 72 hours post-stroke to measure NVC, determined by peak relative increase in cerebral blood velocity (CBv) in the posterior cerebral artery (PCA) during a visual stimulus. Age-, gender-, and vascular risk factor-matched controls were included. The primary outcome was cognitive status at 12 months, evaluated using a 7-point cognitive scale. A total of 144 acute stroke patients and 40 controls were included. NVC exhibited a U-shaped association with long-term cognitive outcomes. Patients in both the lowest (CI95% 2.29 [1.23-4.28], p < 0.01) and highest (CI95% 0.53 [0.29-0.98], p = 0.04) quintiles of NVC magnitude had significantly worse cognitive scores at 12 months compared to those in the reference quintile. NVC assessment via TCD in the acute phase of ischemic stroke may serve as a predictor of long-term cognitive impairment, suggesting that both diminished and exaggerated NVC responses are linked to poorer cognitive outcomes.