Background: Post-stroke cognitive impairment is common and a decisive prognostic factor. However, few studies have reported on post-stroke cognition in young adults, especially long-term cognition. This study was designed to investigate the influence of baseline factors, treatments, and functional outcome on the long-term cognitive outcome in young adults with ischemic stroke. Material/Methods: Consecutive patients aged 18-45 years between January 1, 2006 and December 31, 2010, with a first-ever ischemic stroke, were recruited for cognitive assessment by telephone from December 10 to December 31, 2013 using modified versions of "Telephone Instrument for Cognitive Status" (TICS-m) scale. The relationship of cognitive impairment with baseline factors, treatments, and functional outcome were evaluated. Results: A total of 350 patients with an average age of 41.0 +/- 6.8 years (69.7% males and 30.3% females) were reviewed. The average follow-up period was 5.8 +/- 3.2 years, and cognitive impairment existed in 39.4% of patients at follow-up. Stroke severity on admission, functional outcome (modified Rankin Scale, mRS > 2) at discharge, left anterior circulation syndrome, and stroke recurrence were markedly associated with post-stroke cognitive impairment (all P<0.01). Post-stroke cognition was also significantly related to mRS at follow-up (r=-0.563, P<0.001). Conclusions: Post-stroke cognition was related to functional outcome: hence, treatment directed toward reducing functional disability might also reduce cognitive impairment.