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

Abstract

Background and Aims: Cognitive impairment and dementia are common complications of stroke, but limited knowledge about risk factors restricts mechanistic understanding, prevention, treatment and improvements in patient services. R4VAD is a multi-site longitudinal, inclusive study in 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. More 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. Diagnostic neuroimaging is assessed in all, and high-sensitivity inflammatory blood markers and genetic analysis in as many patients as possible. Recruitment opened in September 2018 aiming to recruit 2000 patients by September 2020. Results: To date, we have recruited 180 participants in 21 Centres in all four UK nations (mean age=72.5 years, SD=10.7; 54% female), 4-19 days post-stroke (mean=9.0). So far, 85% of participants have ischaemic stroke; 6% ICH; 7% TIA; mean NIHSS=2.8 (SD=3.3); 10% lack capacity; 52% have an informant. Prevalent vascular risk factors include: hypertension (72%); hyperlipidaemia (47%); current/ex-smoker (59%); previous stroke/TIA (36%). At baseline, mean scores were: MOCA=23.5/30, SD=4.1;Zung depression=47/80, SD=13.6 (≥50 suggests depression) and anxiety (GAD-7)=4.4/21, SD=4.5 (≥5 suggests anxiety). Conclusions: R4VAD will provide reliable data on cognitive and neuropsychiatric consequences long-term after stroke, improve understanding of clinical, demographic, laboratory, neuroimaging and social predictors of post-stroke cognitive impairment and dementia.