What matters to people and families affected by cerebral small vessel disease (SVD)? A qualitative grounded theory investigation

Hwai, Sophia Wong Ching; Wardlaw, Joanna M.; Williams, Anna; Doubal, Fergus N.

doi:10.1016/j.cccb.2024.100202

Cited by 2 publications

(1 citation statement)

References 11 publications

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“…2 3 Nevertheless, risk-prediction for the development of PSCI and PSD after stroke/TIA remains challenging. 2 4 Although cognitive impairment is the top concern of many stroke survivors, 5 data are limited regarding rates and progression of PSCI by time and clinically-relevant strata that account for pre-morbid and pre-stroke cognition, medical, lifestyle and socioeconomic factors. 2 Improved understanding of these predictors would improve risk stratification and identify mechanisms and intervention targets.…”

Section: Introductionmentioning

confidence: 99%

Rates, risks and routes to reduce vascular dementia (R4VaD), a UK-wide multicentre prospective observational cohort study of cognition after stroke: baseline data and statistical analysis plan (ISRCTN18274006)

Bath,

Backhouse,

Brown

et al. 2024

Preprint

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Background: Stroke is often followed by vascular cognitive impairment and vascular dementia; these are the most feared complication of stroke. However, there is limited understanding of post-stroke cognitive impairment. Methods: Rates, Risks and Routes to Reduce Vascular Dementia (R4VaD) is an observational cohort study of post-stroke cognition. Patients with haemorrhagic or ischaemic stroke, or transient ischaemic attack, were recruited within six weeks of stroke from hospitals across the UK. Consent was obtained from patients with capacity or from relatives/friends in those without capacity. The primary outcome is cognition and its severity assessed using a 7-level ordinal outcome. Final cognition will be compared in those with mild stroke/TIA (worst NIHSS <=7) versus severe stroke (NIHSS >7). Secondary outcomes will include function, mood and quality of life. Results: We recruited 2441 patients from 50 hospitals. Of these, 2437 (99.8%) had a qualifying event of stroke or TIA. The mean age was 68.2 years (standard deviation 13.5), females 981 (40.3%), onset to recruitment 6 days [interquartile range 3-13] and diagnosis ICH 193 (7.9%), ischaemic stroke 2101 (86.2%), TIA 143 (5.9%). The distribution of cognition at baseline was: normal 1256 (51.6%), minor neurocognitive disorder-single domain 530 (21.8%), minor neurocognitive disorder-multi domain 320 (13.1%), major neurocognitive disorder-mild 237 (9.7%), major neurocognitive disorder-moderate 90 (3.7%) and major neurocognitive disorder-severe 3 (0.1%). We provide the statistical analysis plan in the appendix. Conclusion: We provide baseline data and the SAP. Final follow-up will be completed in quarter 2 2024. The data highlight the substantial under-appreciated cognitive burden of stroke, even in the first few days and weeks.

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Section: Introductionmentioning

confidence: 99%

Rates, risks and routes to reduce vascular dementia (R4VaD), a UK-wide multicentre prospective observational cohort study of cognition after stroke: baseline data and statistical analysis plan (ISRCTN18274006)

Bath,

Backhouse,

Brown

et al. 2024

Preprint

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Developing treatments for cerebral small vessel disease: a scoping review of licensed interventions for potential repurposing

M Bath,

P Phan,

Clay

et al. 2024

F1000Res

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Background Cerebral small vessel disease (cSVD) is a progressive neurovascular-degenerative condition without specific treatment that causes lacunar stroke, most intracerebral haemorrhage, vascular cognitive impairment (VCI) and several neuropsychiatric conditions. Objectives To conduct a rapid multi-stage scoping review to identify licensed interventions that could be repurposed for testing in cSVD at phase-3. Methods First, we screened preclinical studies of potential relevance to cSVD and used a drug dictionary to identify studies of potential interventions. Separately, we screened clinical studies of relevance to cSVD and VCI. Following merging, we removed drugs that were unsuitable or impractical to assess long-term in the UK. We then performed mini-meta-analyses for shortlisted interventions assessing effects on cognition and scored these for their relevance to cSVD. Results The preclinical review created a long-list of 1,757 deduplicated interventions. Those that were not available in the UK, not expensive or impractical to administer long-term were merged with 62 interventions identified from 75 relevant clinical studies to create a medium-list of 52 interventions. Focussed literature review short-listed ten interventions for review by an independent scientific advisory group; they ranked three as most suitable for immediate testing: metformin, tadalafil and isosorbide mononitrate. Conclusion This rapid review identified three interventions that are suitable for testing in a late phase-3 (platform) trial involving patients with cSVD. The approach could be improved with partial automation, text mining and generative pre-trained transformer approaches which would help manage the large data volumes. Further, our data-driven approach could be combined with genetic or other mechanistic methods to further de-risk future trials.

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What matters to people and families affected by cerebral small vessel disease (SVD)? A qualitative grounded theory investigation

Cited by 2 publications

References 11 publications

Rates, risks and routes to reduce vascular dementia (R4VaD), a UK-wide multicentre prospective observational cohort study of cognition after stroke: baseline data and statistical analysis plan (ISRCTN18274006)

Rates, risks and routes to reduce vascular dementia (R4VaD), a UK-wide multicentre prospective observational cohort study of cognition after stroke: baseline data and statistical analysis plan (ISRCTN18274006)

Developing treatments for cerebral small vessel disease: a scoping review of licensed interventions for potential repurposing

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