Abstract Number: Esoc2026a1086 Rates and Risk Factors for Cognitive Impairment Up to Two Years After Stroke: The Multicentre R4vad Study

Abstract Background and aims Post-stroke cognitive impairment (PSCI) causes significant morbidity and mortality, but understanding of its incidence, risk factors and prognosis is limited. The UK-wide longitudinal observational R4VaD study examined PSCI incidence, trajectories and risk factors up to 2-years post-stroke. Methods R4VaD recruited patients ≥18 years within 6 weeks of stroke, collecting clinical, socioeconomic, lifestyle, cognitive and mood data at baseline, 6+/-2 weeks, and 1-and 2-years. Following a validation study, we adapted the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM5) 7-level ordinal neurocognitive scale, mapped outcomes, and analyzed predictors of PSCI to 2 years using multivariate stepdown ordinal regression. Results In 2437 patients (mean age 68.2 years, (range 19-97) 40% female, mean worst NIHSS 4.9 (range 0-35)) ≥ single domain PSCI was evident in 38.3% at 1 year (6.3% had died) and 34.7% at 2 years (11.7% had died). Baseline predictors of DSM5-7 level cognition were, at 1 year: age (OR = 1.02, 95%CI = 1.01-1.02), low education (OR = 1.10, 95%CI = 1.02-1.20) premorbid mRS (OR = 1.25, 95%CI = 1.13-1.38), subjective memory complaints (OR = 1.38 95%CI = 1.07-1.77), intracerebral hemorrhage (OR = 1.48, 95%CI = 1.12-1.96), lower MoCA (OR = 1.08, 95%CI = 1.05-1.11), SVD score (OR = 1.22,95%CI = 1.06-1.41); at 2 years: unemployed (OR = 1.16 95%CI = 1.02-1.31), premorbid mRS (OR = 1.34, 95%CI = 1.20-1.51), mental incapacity (OR = 3.17, 95%CI = 1.52-6.61), hypertension (OR = 1.41, 95%CI = 1.12-1.78), atrial fibrillation (OR = 1.40 95%CI = 1.06-1.83), lower MoCA (OR = 1.09 95% CI = 1.06-1.12), brain frailty score (OR = 1.13 95%CI = 1.00-1.27). Conclusions In this large, representative, national study, risk for PSCI differed at 1-and 2-years. Time, socioeconomic, cognitive, and functional predictors, not just NIHSS, are important when considering long-term risk. Conflict of interest Ellen Backhouse: nothing to disclose; Lisa Woodhouse: nothing to disclose; Rosalind Brown: nothing to disclose; Terry Quinn: has received investigator-initiated funding from BMS and Pfizer for projects on cardiovascular disease and cognition; Fergus Doubal: nothing to disclose; John O’Brien: acted as a consultant for TauRx, Novo Nordisk, Biogen, Roche, Lilly and GE Healthcare and received grant or academic support from Avid/Lilly, Merck and Alliance Medical; Hugh Markus: nothing to disclose; Thompson Robinson: NIHR Senior Investigator; Philip Bath: Chief Investigator of PhEAST and reports receiving honoraria from Phagenesis, DiaMedica, Moleac, Nestle, Sanofi; Joanna Wardlaw: nothing to disclose.