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Transcranial Doppler (TCD) monitoring was performed within 72 hours post-stroke to measure NVC, determined by peak relative increase in cerebral blood velocity (CBv) in the posterior cerebral artery (PCA) during a visual stimulus. Age-, gender-, and vascular risk factor-matched controls were included. The primary outcome was cognitive status at 12 months, evaluated using a 7-point cognitive scale. A total of 144 acute stroke patients and 40 controls were included. NVC exhibited a U-shaped association with long-term cognitive outcomes. Patients in both the lowest (CI95% 2.29 [1.23\u20134.28], p\u2009&lt;\u20090.01) and highest (CI95% 0.53 [0.29\u20130.98], p\u2009=\u20090.04) quintiles of NVC magnitude had significantly worse cognitive scores at 12 months compared to those in the reference quintile. 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