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Cognitive impairments are common among young people who have suffered from ischemic stroke. For a large proportion of them, these impairments persist over time. They include slower information processing, language difficulties, and memory impairments. Severe cognitive impairments also increase the risk of unemployment. These findings come from the doctoral research of Mijntje Schellekens of the Radboud university medical center.
In the Netherlands, around two to three thousand people aged 18 to 50 suffer a stroke each year. Remarkably, this number has continued to rise in recent years, according to neurologist Frank-Erik de Leeuw. In most cases, it concerns an ischemic stroke, where a blood clot blocks an artery to the brain. As a result, part of the brain no longer receives oxygen and nutrients. This can lead to physical symptoms such as paralysis, but also to thinking problems: so-called cognitive impairments.
Cognitive impairments may manifest as slower information processing, language difficulties, or memory problems. According to the dissertation by neurology resident Schellekens, these impairments are common among young people after ischemic stroke. For example, more than one-third had difficulties with visuospatial skills, which are essential for daily activities such as reading maps, parking, or copying figures. In addition, nearly one-quarter experienced slower information processing, which can affect how quickly someone responds in conversations or makes decisions.
Long-term problems
Schellekens also examined whether cognitive impairments improve over time. Often, they do not. More than half of young people still had cognitive impairments one year after ischemic stroke. In 10%, the condition even worsened.
These cognitive impairments affect not only health but also social functioning. ‘Most young people are in the midst of life, with an active social life, a young family, and a busy career,’ says Schellekens. ‘Cognitive impairments after ischemic stroke often have a major impact on this. Their social relationships and quality of life suffer as a result.’
Higher risk of unemployment
Brain injury also affects their return to working life. The dissertation shows that most young people do return to work after ischemic stroke. However, those with slower information processing or severe cognitive impairments were twice as likely to be unemployed six years later. This is independent of any physical impairments caused by the stroke. Unemployment has a huge impact on their social participation. ‘Returning to work is incredibly important for young people after ischemic stroke to feel they have a role in society again,’ says de Leeuw.
Recognition and awareness
According to Schellekens, too little attention is paid to cognitive impairments in young people after ischemic stroke. She therefore advocates for greater awareness: ‘By screening young people for cognitive impairments after ischemic stroke, we can identify problems at an early stage and take them into account. The next step is to investigate which treatments are effective.’ De Leeuw adds: ‘Recognizing and acknowledging cognitive impairments after ischemic stroke are crucial. By informing patients that they may feel fatigued or sensitive to stimuli, impairments often make more sense and understanding increases.’
PhD student and neurology resident Mijntje Schellekens.
More information about the PhD defense
Defense on 14 January 2026, at 14:30 by Mijntje Schellekens. Dissertation title: Cognitive impairment after stroke in young adults (online available after 14 January). Supervisor: prof. dr. F de Leeuw. Co-supervisor: dr. A.M. Tuladhar. The defense can be followed via this livestream.
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