Inclusion Criteria- Ischemic stroke and measurable deficit on the initial NIHSS (> 1)
- Cognitive impairment within the 5th and 50th percentiles for age, race, and education based on Montreal Cognitive Assessment (MoCA) or 2 out of 5 delayed recall or less on the MoCA.
- Able to sign informed consent, have a caregiver, and live within a reasonable driving distance from Wake Forest Baptist Medical Center.
Exclusion Criteria- Patients under age 40 or 90 years or older
- Living in skilled nursing facility
- Severe stroke deficits at 4 weeks that prohibit participation in cognitive testing (global or receptive aphasia, or severe expressive aphasia)
- Diabetes requiring insulin
- Psychiatric disorders
- Severe head trauma
- Neurologic disorders other than stroke
- Renal disease
- hepatic disease
- chronic obstructive pulmonary disease
- unstable cardiac disease
- those with prior deficits in ADLs and IADLs