Post-stroke cognitive impairment (PSCI) affects up to one-third of stroke survivors and is a major cause of long-term disability and reduced quality of life. Its heterogeneous presentation reflects the interplay of acute ischemic injury, chronic vascular pathology, inflammation, blood–brain barrier dysfunction, and frequently co-existing neurodegeneration. Core symptoms depend on lesion location and variably include executive dysfunction and attention deficits, often accompanied by memory, language, visuospatial, and psychiatric symptoms. Often, cardiac comorbidity plays a role.

Accurate diagnosis remains challenging, as covert cerebrovascular pathology and overlapping neurodegenerative processes, cardiac and other comorbidites frequently confound and contribute to the overall picture. Neuroimaging, fluid biomarkers, validated bedside tests and extended neuropsychological assessment are important assessment tools.

Therapeutic approaches are limited. Non-pharmacological interventions—including cognitive rehabilitation, physical exercise, and multimodal neurorehabilitation—are currently the cornerstones of management, especially when initiated early and tailored to individual patient profile. Preventive strategies focusing on vascular risk-factor control, lifestyle modification, cognitive reserve, and social engagement remain essential, with marked regional variability highlighting the need for culturally adapted approaches.

A personalized precision medicine framework—stratifying patients by imaging-defined subtypes, cognitive profiles, and underlying pathology—holds promise for improving treatment effectiveness through targeted interventions. Future research should prioritize harmonized diagnostic pathways, patient-centered outcomes, and integration of cognitive health into routine stroke care.