OBJECTIVE: Little is known about cognitive differences between patients showing neglect and those without neglect in their acute stroke stage. The aim of this study was to investigate how the patients with neglect (N+) differ from those without neglect (N-) in general cognitive function assessed by the Mini-Mental State Examination (MMSE). METHODS: Patients consisted of 98 consecutive patients with acute right hemisphere stroke. The patients underwent neglect test battery followed by MMSE in the same day. RESULTS: The frequency of cognitive deficits in N+ group was higher than that of N- group (74.1% vs. 35.0%). A regression analysis, after controlling for lesion volume, age, and education, showed that neglect was a significant predictor of low MMSE score. Among MMSE subdomains, the severity of neglect was related to poor performances on episodic memory (orientation and 3-word recall), working memory/calculation (serial 7s), and constructional praxis (interlocking pentagons). CONCLUSIONS: These results suggest that hemispatial neglect is associated with several forms of cognitive deficits in patients with acute right hemisphere stroke. © 2008 by Lippincott Williams & Wilkins.