Vascular cognitive impairment (VCI) can affect both young (<60 years old at onset) and old ischemic stroke survivors. Elucidating the specific risk profiles for delayed VCI in young and old patients will be useful in risk stratification and intervention with pharmacological and non-pharmacological measures. 854 ischemic stroke survivors from Singapore and Hong Kong with no pre-stroke decline were studied. Risk factor and MRI data from time of stroke was collected. Subjects were reviewed at 6 months post-stroke for cognitive assessment. A subcohort of 637 subjects was additionally reviewed 18 months post-stroke. Prevalence of VCI at both time-points was compared between old and young subjects. Stepwise logistic regression models predicting VCI and 6 months and 18 months for old and young subjects were used to describe specific risk profiles. 206 subjects (24.12%) were <60 years old at time of stroke. Overall prevalence of VCI was 44.6% at 6 months, and 49.3% at 18 months. Older subjects had less education and more risk factors, such as hypertension, prior stroke, atrial fibrillation, cortical atrophy, white matter hyperintensities, and chronic lacunes. VCI at 6 months was 18.9% for young subjects and 52.8% for old subjects.[Table 1] Increase of VCI between 6 months and 18 months was greater among the older stroke subjects (51.2% to 56.8%) as seen in the follow-up subcohort.[Figure 1] Education and chronic lacunes were significant predictors of VCI at both time-points for young subjects. Age, education, diabetes mellitus, and chronic lacunes were significant predictors for VCI for older subjects, with acute cortical large infarcts being an additional risk factor only at 6 months.[Table 2]. Older stroke survivors have a greater prevalence of VCI and continue to have higher increase in prevalence from months 6 to months 18 compared to younger patients. Low education and burden of chronic lacunes are common risk factors for VCI at all age and chronicity levels. Acute infarct characteristics are salient only for VCI in older subjects at months 6, but not for VCI at month 18. Chronic risk factors, not acute, are more predictive of long-term cognitive status in ischemic stroke survivors. Prevalence of VCI in young and old stroke survivors at 6 months and 18 months post-stroke in the follow-up subcohort