Eligibility Criteria

Inclusion Criteria

- Diagnosed with cerebral infarction/TIA hospitalized at New York Presbyterian Hospital (Milstein Hospital and Allen Pavilion)
- 18 year-old and older at onset of the stroke
- Self-identified as of White, Black or Hispanic race-ethnicity
- Living in a household with a telephone

Exclusion Criteria

- Patients unable to give informed consent
- Discharged to nursing home or requiring 24 hour care.
- A Modified Rankin score > 4 at baseline
- Severe aphasia or severe cognitive impairment limiting comprehension
- Pre-stroke dementia history
- Patients with end stage cancer, or other medical conditions resulting in mortality