Post-stroke Vascular Cognitive Impairment in India: A National Survey of Healthcare Professionals' Clinical Practices.

Background and rationale International guidelines recommend treatment for post-stroke cognitive impairment (PSCI), yet there are few evidence-based approaches to guide intervention, leaving clinicians uncertain about how to intervene. Little is known about healthcare professionals' approach to post-stroke cognitive rehabilitation. This survey provides the first data on how PSCI is recognized and managed in stroke units in India. Aim This survey aimed to understand whether and how healthcare professionals, including neurologists, physiotherapists (PTs), nurses, occupational therapists (OTs), and speech-language pathologists (SLPs), assess and treat patients with PSCI in India, and to explore barriers and facilitators that influence treatment delivery. Study method A multicenter online survey was conducted across 50 hospitals within the Indian Stroke Clinical Trial Network (INSTRuCT). We used a purposive sampling approach to enroll healthcare professionals involved in stroke care. Results Of the 110 respondents, 47% were neurologists, 19% PTs, 22% nurses, 10% OTs, and 0.9% SLPs. Approximately 67% reported performing routine cognitive screening, primarily using the Montreal Cognitive Assessment (MoCA; 46%) and the Mini-Mental State Examination (MMSE; 37%). Seventy percent reported providing cognitive rehabilitation interventions, primarily aerobic exercises, strategy-based interventions, and cognitive skills training. Key barriers to providing cognitive rehabilitation included lack of time, insufficient training and expertise, and the team prioritizing other aspects of recovery before cognition. Conclusion This first national multicenter survey provides important insight into the current state of PSCI assessment and rehabilitation in India, identifying variation in clinical practice and persistent barriers to cognitive care. Given India's large and growing stroke burden, these findings are clinically significant as unrecognized and undertreated PSCI may adversely affect long-term recovery and quality of life. The study highlights an urgent need for context-specific cognitive rehabilitation pathways and workforce training, with implications not only for India but also for other low-and middle-income countries facing similar resource and rehabilitation challenges.