Background: Cognitive impairment is a frequent sequela of stroke, with type 2 diabetes mellitus (T2DM) acting as an independent risk factor for exacerbated cognitive decline. Early detection and characterization of cognitive deficits in post-stroke patients are essential for rehabilitation planning. The Montreal Cognitive Assessment (MoCA) offers a sensitive screening tool for cognitive dysfunction, while magnetic resonance imaging (MRI) helps localize structural brain changes. This study aims to compare cognitive performance between T2DM and non-diabetic stroke survivors and assess MRI correlates of cognitive deficits. Materials and Methods: A cross-sectional observational study was conducted involving 60 ischemic stroke survivors aged 45–75 years, divided into two groups: Group A (n=30) with T2DM and Group B (n=30) without T2DM. All participants underwent cognitive evaluation using the MoCA within three months post-stroke. MRI brain scans were analyzed for lesion location, white matter hyperintensities (WMHs), and hippocampal atrophy. Statistical analysis was performed using SPSS version 25. Independent t-tests and Pearson correlation were applied to compare cognitive scores and MRI findings between the groups. Results: The mean MoCA score was significantly lower in the diabetic stroke group (21.4 ± 3.1) compared to the non-diabetic group (24.8 ± 2.6), p<0.01. MRI analysis showed a higher prevalence of bilateral WMHs and medial temporal lobe atrophy in diabetic participants. A significant inverse correlation was noted between WMH burden and MoCA scores (r = -0.62, p<0.01). Additionally, hippocampal atrophy was more severe in the T2DM group, aligning with lower memory domain scores on MoCA. Conclusion: Stroke survivors with type 2 diabetes exhibit more pronounced cognitive impairment compared to non-diabetic counterparts. The combination of MoCA assessment and MRI findings provides a valuable approach for early detection and monitoring of post-stroke cognitive decline, particularly in diabetic patients who are at higher risk. Targeted cognitive rehabilitation strategies should consider the additional burden imposed by diabetes on brain structure and function.

Cognitive impairment, Type 2 diabetes mellitus, Stroke survivors, Montreal Cognitive Assessment, MRI, White matter hyperintensities, Hippocampal atrophy.