Incomplete Cognitive Assessment in Post-Acute Stroke Rehabilitation: Recovering Clinically Interpretable Relationships from Routine Neuropsychological Data

BackgroundIn post-acute stroke rehabilitation, cognitive assessment is clinically important but frequently incomplete. Complete-case analysis excludes much of the sample, reducing representativeness.ObjectivesTo determine whether incomplete routine post-stroke cognitive assessments can still yield clinically interpretable relationships among cognitive, clinical, and contextual variables, and support group-level stratification using a reduced feasible cognitive set.MethodsRetrospective cohort study of adults admitted to post-acute stroke neuro-rehabilitation between 2007 and 2026 with at least one neuropsychological assessment. The baseline cohort included 2654 patients, with 5417 assessments within 6 months available for confirmatory analysis. The 24-subtest baseline battery showed 37.5% to 88.4% missingness. Five representative cognitive measures were selected based on data availability, domain coverage, and within-domain Spearman correlations. Bayesian networks were fitted in the baseline cohort, their stability was assessed by bootstrapping, key dependencies were examined across all available assessments.ResultsStable, bootstrap-supported dependency patterns were recovered and broadly replicated in the confirmatory analysis. Replicated associations linked age and time since injury to verbal learning and naming; stroke subtype to verbal learning, timed orientation/performance, and phonemic fluency. Verbal learning occupied a central position, with additional replicated links to naming, timed orientation/performance, and attentional span. Among the contextual variables, economic status was the only one showing a direct link to a cognitive measure (attentional span). Group-level stratification of verbal learning showed moderate performance (R2 = 0.42).ConclusionsIncomplete routine cognitive assessments need not rely on complete-case restriction or score imputation; they can still support clinically meaningful interpretation and group-level stratification in post-acute stroke rehabilitation.