136Rates, risks and routes to reduce vascular dementia (R4VAD)

Abstract

Introduction: R4VAD is a multi-site longitudinal, inclusive observational study of patients presenting with stroke to UK stroke centres aiming to determine rates of, and risk factors for, cognitive and related impairments after stroke, assess mechanisms and improve prediction models. Methods: R4VaD is recruiting patients within six weeks of stroke and collecting clinical, socioeconomic, lifestyle, cognitive, mood and informant data using clinical trial methods. Detailed assessments are obtained at 6+/-2 weeks post-baseline assessment, with annual follow-up by phone and post to at least 2 years plus data linkage for 10 years. Diagnostic neuroimaging is assessed in all, and inflammatory blood markers and genetic analysis in as many patients as possible. Recruitment opened in September 2018, paused briefly in March 2020 and reopened in April 2020 with a COVID-19 sub study. Results: To date, we have recruited 2137 participants (initial a target 2000) in 53 Centres across theUK (mean age=68.5 years, SD=13.5; 39.8% female), 0-15 days post-stroke. So far, 85% of participantshave ischaemic stroke; 8% ICH; 6% TIA; mean NIHSS=2.9 (SD=3.4); 6% lack capacity; 31% have aninformant. Prevalent vascular risk factors include: hypertension (63%); hyperlipidaemia (45%); current/ex-smoker (58%); previous stroke/TIA (28%). At baseline, mean scores were: MOCA=23.0/30, SD=4.2; Zung depression=46.0/80, SD=13.5 (≥50 suggests depression) and anxiety (GAD-7)= 3.9/21, SD=4.8 (≥5 suggests anxiety). Conclusions: R4VAD will provide reliable data on cognitive and neuropsychiatric consequences longtermafter stroke; improve understanding of clinical, demographic, laboratory, neuroimaging and socialpredictors of post-stroke cognitive impairment and dementia as well as provide objective data on theimpacts of COVID-19 on stroke.