Incidence and associated factors of major VCI in first-ever ischemic stroke patients with mild VCI: a five-year prospective cohort study

Abstract

Background Long-term outcomes of ischemic stroke patients having mild vascular cognitive impairment (VCI) are not well-known. The aim of this study was to investigate the five-year outcomes of ischemic stroke patients with mild VCI. Methods This study analyzed data from the Korean Stroke Cohort for Functioning and Rehabilitation study. Patients were recruited from August 2012 through May 2015. We included patients who survived five-year after stroke onset and were classified as having mild VCI at six-month post-onset. Assessments were performed serially from sixmonth to five-year post-onset. Cognition was assessed by Korean version of Mini-Mental Status Examination (K-MMSE). Functional Independence Measure (FIM) was used to assess activities of daily living (ADL) of the participants. Vascular Impairment of Cognition Classification Consensus Study (VICCCS) guideline was used to define VCI condition. Longitudinal trajectories of VCI condition and K-MMSE, including the specific domains, were identified. Multivariable logistic regression analysis was performed, to demonstrated factors associated with progression to major VCI condition. Findings A total of 998 patients were included. At five-year post-onset, 136 (13.6%) patients progressed to major VCI condition. Older age (OR 1.09, 95% CI 1.06 similar to 1.12), presence of diabetes (OR 1.83, 95% CI 1.15 similar to 2.88) and atrial fibrillation (OR 2.47, 95% CI 1.25 similar to 4.79), high level of education (OR 0.32, 95% CI 0.10 similar to 0.90), etiology of small vessel occlusion (OR 1.95, 95% CI 1.18 similar to 3.22), higher FIM score at six-month (OR 0.90, 95% CI 0.85 similar to 0.96), impairment in the attention and calculation domain of the K-MMSE at six-month (OR 2.10, 95% CI 1.25 similar to 3.61), and longer hospitalization (OR 1.04, 95% CI 1.02 similar to 1.05) were associated with the risk of being classified as having major VCI at five-year. Interpretation This study investigated the incidence and associated factors of major VCI in patients with mild VCI. The results provide insights into cognitive decline trajectories in this population, enabling the development of targeted management strategies to mitigate disease progression. Funding The Research Program funded by Korea Disease Control and Prevention Agency. Copyright (c) 2026 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).