Hochstenbach JB, den Otter R, Mulder TW. Cognitive recovery after stroke: a 2-year follow-up. Arch Phys Med Rehabil 2003;84:1499–504. Objectives To determine (1) whether long-term improvement of cognitive function takes place after stroke and (2) which clinical factors influence cognitive recovery. Design Cohort study with patients who were assessed at 2.3 and 27.7 months after stroke. Setting Home-based stroke patients. Participants From a group of 229 stroke patients, 92 were approached to participate. Sixty-five (43 men, 22 women; mean age, 56.4y) agreed, and they were neuropsychologically assessed at 72.2 days after stroke. A group of 33 controls (12 men, 21 women; mean age, 52.4y) was used as a reference sample. Interventions Not applicable. Main outcome measures Orientation, memory, attention, visuospatial, visuoconstructive, language, and arithmetic abilities were assessed with an extensive neuropsychologic test battery. Results Significant improvements across time were noted for all cognitive domains. The biggest improvement was found in the attentional domain; the least, in the memory domain. In addition, a small subset of patients accounted for the significant improvement in all cognitive domains; most patients showed no improvement or declined. Factors influencing recovery were side of the stroke and incidence of lowered consciousness on admission. Patients with right-side brain damage performed better than those with left-side brain damage and showed more improvement over time. Patients with lowered consciousness on admission performed worse than patients without lowered consciousness. No significant effect was found for gender, type of stroke, cortical versus subcortical lesions, having 1 stroke or multiple strokes, or the interval between the stroke and the neuropsychologic assessment. Conclusion There was room for improvement in all cognitive domains, although this improvement was gained by only a small number of patients. Hence, most patients must cope with serious permanent cognitive decline after stroke.