Results:

The community-based South London Stroke Register covers an inner-city multiethnic source population of 271,817 inhabitants, of which 4,413 patients had their first-ever stroke between January 1, 1995, and December 31, 2011, of whom 1,137 (26%) were dead within 3 months, 689 (16%) were not eligible because of late registration or because their date of follow-up was not reached, and 575 (13%) were unable to undergo a cognitive assessment because of a severe verbal, visual, or hearing impairment. Of the 2,012 remaining subjects, 1,682 stroke survivors were able to undergo a cognitive assessment at 3 months, 1,448 at 1 year, 684 at 5 years, and 200 at 10 years. Among patients with ischemic strokes without a history of atrial fibrillation (AF), there was a reduced risk of cognitive impairment associated with the use of different prevention treatments: 1) antihypertensive medications (relative risk [RR], 0.7 [95% confidence interval (CI), 0.57-0.82] for diuretics; RR, 0.8 [95% CI, 0.64-0.98] for angiotensin-converting enzyme inhibitors; and RR, 0.7 [95% CI, 0.55-0.81] for their combination), 2) a combination of aspirin and dipyridamole (RR, 0.8 [95% CI, 0.68-1.01]), and 3) statin (RR, 0.9 [95% CI, 0.76-1.06]) when clinically indicated. Protective effects against cognitive impairment were also observed in patients on the combination of antihypertensive medications, antithrombotic agents, and lipid-lowering drugs (RR, 0.55 [95% CI, 0.40-0.77]). No significant associations were noted between post-stroke cognitive impairment and antihypertensive medications among hemorrhagic stroke patients.