Abstract Number: Esoc2026a1402 Cognitive Reserve Proxy and Post-Stroke Cognitive Impairment: A Multicenter, Prospective Cohort Study

Background and aims The impact of cognitive reserve (CR) on post-stroke cognitive impairment (PSCI) remains unclear. This study aims to explore the association between CR constructed from multiple proxy indicators and PSCI. Methods Included were acute ischemic stroke patients with normal baseline cognition who completed 3-month cognitive follow-up. CR proxies were derived from education level and living area. PSCI was defined as Montreal Cognitive Assessment (MoCA) score < 25 at 3-month follow-up. Results Of the 1,682 included acute ischemic stroke patients, 1,019 (60.6%) were diagnosed with PSCI at the 3-month follow-up.CR was an independent protective factor for PSCI (odds ratio [OR] = 0.89; 95% confidence interval [CI]: 0.81-0.98; P=0.01). Subgroup analysis showed significant interactions between CR and TOAST classification, as well as white matter hyperintensities (WMH) (all P < 0.05). Conclusions CR appears a pivotal protective factor for PSCI, and its clinical value closely tied to stroke subtypes and neuroimaging features suggests it could serve as a key target for PSCI prevention and personalized care. Conflict of interest Minghua Wang. nothing to disclose; Yufei Wei.nothing to disclose; Liping Liu.nothing to disclose.