Vascular dementia: investigating cognitive impairment with 2,000 stroke survivors

The money from DPUK was used to cover the initial patient and staffing costs required to set up R4VaD (Rates, Risks & Routes to Reduce Vascular Dementia), and now the researchers are nearing their goal of 2,000 participants. Since 2018, the team has been busy recruiting people who have recently had a stroke of any severity to take part in what the project manager, Dr Ellen Backhouse, describes as a ‘deeper dive into the stroke population’. Dr Backhouse said: ‘Our aim is to collect a very wide, very broad measure of the consequences of stroke and the risk factors for stroke in a large population.’

The scope of the R4VaD study is outlined in a new protocol paper published in European Stroke Journal. Eligible patients are invited to get involved when they attend stroke services and are then put in touch with the research team. Over two years, Professor Wardlaw and her colleagues will collect a wide range of data on their participants, including pre-stroke measurements such as lifestyle and socioeconomic status, as well as taking measurements of neuropsychiatric health to assess for cognitive decline, mental health and fatigue. Dr Backhouse said: ‘We’re looking at the cognitive consequences of stroke because cognition is something that is really affected in patients that have had a stroke, but it is often neglected as people look more at the physical consequences of stroke.’

Dr Backhouse explained another reason why this study is so novel: ‘We’re aiming to collect this information on a wide range of patients with different stroke severities and cognitive abilities at the onset of the study. Lots of studies concentrate mostly on mild strokes because there are difficulties associated with recruiting more severe strokes, but we’re hoping to have a spread of all different patients ranging from very mild to much more severe strokes. We will include people who have capacity to consent and also those that don’t [by obtaining informed consent from their caregivers].’

The data are collected from participants via an initial cognitive screening as soon as 24 hours after their stroke. During this screening, the researchers assess for delirium, apathy, depression and frailty, as well as obtaining medical test results relating to the stroke. Participants then receive a follow-up visit around six weeks after this for further testing, which includes blood sampling in a smaller group of patients. After this, the stroke survivors will have annual follow-ups for at least two years by phone or post consisting of another cognitive assessment and questions regarding any new issues relating to their vascular health.

Once they have all the data they need, the scientists will identify who went on to develop vascular dementia and compare any similarities they may have in order to identify any risk factors. If they do find that certain aspects of stroke particularly affect cognition, then those can be targeted to improve recovery from stroke and stave off vascular dementia. Vascular dementia currently has no viable treatment, so studies like R4VaD are crucial for preventing the condition and preserving people’s quality of life.

R4VaD is one of DPUK’s Experimental Medicine projects, more information about which can be found in the final report from DPUK. Stroke Association, British Heart Foundation and Alzheimer’s Society also provided crucial funding to make this study possible.