{"id":4665,"date":"2024-05-14T11:00:07","date_gmt":"2024-05-14T10:00:07","guid":{"rendered":"https:\/\/blogs.imperial.ac.uk\/imperial-medicine\/?p=4665"},"modified":"2024-11-05T11:24:00","modified_gmt":"2024-11-05T11:24:00","slug":"stroke-survivor-cognitive-health","status":"publish","type":"post","link":"https:\/\/blogs.imperial.ac.uk\/imperial-medicine\/2024\/05\/14\/stroke-survivor-cognitive-health\/","title":{"rendered":"Stroke survivors\u2019 cognitive health under the spotlight: New research aims to improve diagnosis and treatment"},"content":{"rendered":"<p><strong><img loading=\"lazy\" decoding=\"async\" width=\"2560\" height=\"1707\" class=\"aligncenter wp-image-4666 size-full\" src=\"https:\/\/blogs.imperial.ac.uk\/imperial-medicine\/files\/2024\/05\/230526_DG_ICL_DBSc-080-scaled.jpg\" alt=\"Dr Fatemeh Geranmayeh\" \/><\/strong><\/p>\n<p><strong>Did you know stroke is the largest cause of disability in the UK and the fourth biggest killer? To mark Stroke Awareness Month, Dr Fatemeh Geranmayeh from the Department of Brain Sciences sheds light on her recent research looking at the recovery of cognitive functions after cerebrovascular disease and the \u2018prediction problem.\u2019\u00a0\u00a0<\/strong><\/p>\n<hr \/>\n<p>S<span data-contrast=\"auto\">troke is a leading cause of death and disability worldwide. Given that stroke strikes every five minutes here in the UK, chances are that you personally know someone affected by stroke.\u00a0 <\/span><span data-contrast=\"none\">Of the 1.3 million stroke survivors, three quarters have problems with cognition (that is problems with memory, thinking, language, problem solving, numbers or planning actions). A significant proportion (a third) develop dementia within five years. It&#8217;s not surprising therefore that vascular brain health is beginning to get the attention that it deserves in the field of dementia research. <\/span><span data-ccp-props=\"{&quot;134233117&quot;:true,&quot;134233118&quot;:true,&quot;335551550&quot;:6,&quot;335551620&quot;:6,&quot;335557856&quot;:16777215}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"none\">The spectrum of post-stroke cognitive deficits is broad with significant negative impacts on therapy engagement, mental health, employment and societal costs. Consequently, diagnosis and treatment of cognitive impairment following stroke have been highlighted as priority by <\/span><a href=\"https:\/\/www.stroke.org.uk\/sites\/default\/files\/research\/priorities_in_stroke_rehabilitation_and_lon-term_care.pdf\"><span data-contrast=\"none\">patients<\/span><\/a><span data-contrast=\"none\"> and national <\/span><a href=\"https:\/\/www.strokeguideline.org\/app\/uploads\/2023\/04\/National-Clinical-Guideline-for-Stroke-2023.pdf\"><span data-contrast=\"none\">guidelines<\/span><\/a><span data-contrast=\"none\"> for stroke management.<\/span><span data-ccp-props=\"{&quot;134233117&quot;:true,&quot;134233118&quot;:true,&quot;335551550&quot;:6,&quot;335551620&quot;:6,&quot;335557856&quot;:16777215}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"none\">From a research perspective, much effort has been put into understanding the \u2018prediction problem\u2019; that is which patients are likely to a) recover cognition, b) show cognitive deterioration requiring additional monitoring and care needs, and c) benefit most from personalised therapy.\u00a0 <\/span><span data-ccp-props=\"{&quot;134233117&quot;:true,&quot;134233118&quot;:true,&quot;335551550&quot;:6,&quot;335551620&quot;:6,&quot;335557856&quot;:16777215}\">\u00a0<\/span><\/p>\n<p><!--more--><\/p>\n<p><span data-contrast=\"none\">Much of this work began with classic lesion-behaviour mapping &#8211; <\/span><span data-contrast=\"auto\">examinations of how specific brain lesions, typically resulting from injury or disease, correlate with particular behavioural deficits or changes<\/span><span data-contrast=\"none\"> &#8211; by the neuroscience giants of the 19<\/span><span data-contrast=\"none\">th<\/span><span data-contrast=\"none\"> and early 20<\/span><span data-contrast=\"none\">th<\/span><span data-contrast=\"none\"> century, such as those by Karl Wernicke, Paul Broca, Norman Geschwind and Wilder Penfield to name a few. More recently these cognitive functions, previously localised to a single lesion, are thought to be mediated via a <\/span><a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S0093934X16300475?via%3Dihub\"><span data-contrast=\"none\">more distributed network of brain regions<\/span><\/a><span data-contrast=\"none\">. Therefore, the residual brain function after stroke is not only dictated by the stroke lesion anatomy, but also by the health of the rest of the brain. The latter is largely dictated by global brain aging, pre-existing neurodegenerative pathology or small vessel disease. Furthermore, post-stroke cognition is additionally affected by mood disorders which are themselves incredibly common after stroke (1\/4 of patients have depression after stroke).<\/span><span data-ccp-props=\"{&quot;134233117&quot;:true,&quot;134233118&quot;:true,&quot;335551550&quot;:6,&quot;335551620&quot;:6,&quot;335557856&quot;:16777215}\">\u00a0<\/span><\/p>\n<figure id=\"attachment_4670\" aria-describedby=\"caption-attachment-4670\" style=\"width: 2560px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" width=\"2560\" height=\"1751\" class=\"wp-image-4670 size-full\" src=\"https:\/\/blogs.imperial.ac.uk\/imperial-medicine\/files\/2024\/05\/CLC_lab_2024-scaled.jpg\" alt=\"The Clinical Language and Cognition lab, led by Dr Fatemeh Geranmayeh.\" \/><figcaption id=\"caption-attachment-4670\" class=\"wp-caption-text\">The Clinical Language and Cognition lab, led by Dr Fatemeh Geranmayeh.<\/figcaption><\/figure>\n<p><span data-contrast=\"none\">To address this gap, the Clinical Language and Cognition lab, led by <\/span><a href=\"https:\/\/www.imperial.ac.uk\/people\/fatemeh.geranmayeh00\"><span data-contrast=\"none\">Dr Fatemeh Geranmayeh<\/span><\/a><span data-contrast=\"none\">, funded by the <\/span><a href=\"https:\/\/www.ukri.org\/councils\/mrc\/\"><span data-contrast=\"none\">Medical Research Council<\/span><\/a><span data-contrast=\"none\">, is conducting a large study of patients with stroke entitled the <\/span><a href=\"https:\/\/www.ic3study.co.uk\/\"><span data-contrast=\"none\">IC3 study<\/span><\/a><span data-contrast=\"none\"> (Imperial Comprehensive Cognitive assessment in Cerebrovascular disease). This is a <\/span><a href=\"https:\/\/bmjopen.bmj.com\/content\/13\/11\/e076653.info\"><span data-contrast=\"none\">longitudinal observational<\/span><\/a><span data-contrast=\"none\"> study, currently open to recruitment, with the aim of improving prediction of post-stroke cognitive outcomes using deep cognitive phenotyping \u2013 assessing and categorising participants based on their cognitive abilities, clinical characteristics and performance. (see ClinicalTrials.gov: NCT05885295). The overall aim is to improve prediction of stroke outcome by taking a holistic view using multimodal brain imaging (structural and functional brain imaging), and <\/span><span data-contrast=\"auto\">blood biomarkers of neuroaxonal injury &#8211;<\/span><span data-contrast=\"auto\"> damage to the brain&#8217;s long connecting nerve fibers (axons)<\/span><span data-contrast=\"auto\">, non-specific neurodegeneration as well as Alzheimer&#8217;s-specific pathology. The latter blood biomarkers have not been studied in patients with significant vascular disease burden, and in fact patients with stroke were largely excluded from the studies that confirmed the role of these blood biomarkers in Alzheimer&#8217;s disease. Therefore, there is a need to study them in patients with stroke.\u00a0<\/span><span data-ccp-props=\"{&quot;134233117&quot;:true,&quot;134233118&quot;:true,&quot;335551550&quot;:6,&quot;335551620&quot;:6,&quot;335557856&quot;:16777215}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">As part of the IC3 study, we have been developing an online cognitive testing tool to allow reliable and cheap testing of cognition in patients after stroke. We have tested this in over six thousand older adults, and validated its use against commonly used clinical cognitive assessments in patients with stroke.\u00a0<\/span><span data-ccp-props=\"{&quot;335551550&quot;:6,&quot;335551620&quot;:6,&quot;335559739&quot;:75}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"none\">Despite the national recommendations for cognitive testing in patients with stroke, many patients with cognitive impairment remain undiagnosed, and untreated with significant impact on their life and that of their carers. This is largely due to cost and workforce pressures facing the NHS, with severe shortage of psychology services for stroke, currently at 10% of the required level, according to the latest <\/span><a href=\"https:\/\/www.strokeaudit.org\/Documents\/National\/Clinical\/Apr2022Mar2023\/Apr2022Mar2023-AnnualReport.aspx\"><span data-contrast=\"none\">national audits.<\/span><\/a><span data-contrast=\"none\"> Furthermore, in the absence of a gold-standard approach for identifying these deficits<\/span><span aria-label=\"Rich text content control\"><span data-contrast=\"none\">\u200b,<\/span> <span data-contrast=\"none\">\u200b<\/span><\/span><span data-contrast=\"none\">clinicians often adopt an ad-hoc selection of cognitive tests which are largely insensitive to mild stroke-specific impairments. <\/span><span data-ccp-props=\"{&quot;335551550&quot;:6,&quot;335551620&quot;:6,&quot;335559739&quot;:75}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"none\">We hope to develop the IC3 online cognitive testing tool further for use in the clinical setting. <\/span><span data-contrast=\"none\">As a cost-effective, sensitive, and scalable tool for rapid cognitive phenotyping of patients with stroke and related vascular disorders, we hope that the IC3 will address significant unmet clinical benchmarks and research priorities. In the healthcare setting, it will deliver personalised testing and triaging of a wide range of disorders with vascular components, e.g. after stroke, allowing diversion of limited resources to therapy provision. In the research setting, it would facilitate drug\/rehabilitation trial monitoring and large-scale mechanistic population-based studies as a standard cognitive outcome measure. <\/span><span data-ccp-props=\"{&quot;335551550&quot;:6,&quot;335551620&quot;:6,&quot;335559739&quot;:75}\">\u00a0<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Did you know stroke is the largest cause of disability in the UK and the fourth biggest killer? To mark Stroke Awareness Month, Dr Fatemeh Geranmayeh from the Department of Brain Sciences sheds light on her recent research looking at the recovery of cognitive functions after cerebrovascular disease and the \u2018prediction problem.\u2019\u00a0\u00a0 Stroke is a [&hellip;]<\/p>\n","protected":false},"author":1807,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[302804],"tags":[272432,306283,11177,306282],"class_list":["post-4665","post","type-post","status-publish","format-standard","hentry","category-department-of-brain-sciences","tag-brain-science","tag-cognitive-health","tag-dementia","tag-stroke"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - 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