Predictors and Biomarkers for VCID versus Cognitive Recovery after Stroke Thrombectomy in Rural Appalachia
阿巴拉契亚农村地区中风血栓切除术后 VCID 的预测因子和生物标志物与认知恢复
基本信息
- 批准号:10659462
- 负责人:
- 金额:$ 67.69万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2023
- 资助国家:美国
- 起止时间:2023-04-15 至 2028-03-31
- 项目状态:未结题
- 来源:
- 关键词:AcuteAddressAffectAlzheimer&aposs DiseaseAlzheimer&aposs disease related dementiaBiologicalBiological MarkersBloodBlood ProteinsBlood specimenBrainCaregiver BurdenCaringCatchment AreaCharacteristicsChronicClinicalCoagulation ProcessCognitionCognitiveCountyDataDementiaDevelopmentEarly DiagnosisEducational workshopEnrollmentEquationExcisionGoalsHealth Services AccessibilityHomeHome visitationImpaired cognitionInflammationInflammatoryJointsLifeMachine LearningMeasuresMechanicsMedical HistoryMedical RecordsMethodsModelingNational Heart, Lung, and Blood InstituteNational Institute of Neurological Disorders and StrokeOutcomeParticipantPatientsPlasmaPositioning AttributeProceduresProteinsProteomicsRegistriesRehabilitation therapyResearchRuralRural AppalachiaRural PopulationSamplingSignal PathwaySiteStatistical ModelsStrokeStroke BeltSuburban PopulationTestingThrombectomyTimeTravelUnderserved PopulationUnited States National Institutes of HealthValidationVenous blood samplingWorkacute strokebarrier to carecare deliverycognitive impairment no dementiacognitive performancecognitive recoverycomorbiditydisabilityfollow-upfunctional improvementhealth care availabilityhealth disparityimprovedmedical complicationmedically underservedmortalityneurocognitive testnovelnovel markernovel therapeutic interventionnovel therapeuticsoutcome predictionpatient populationpost strokepost stroke cognitive impairmentprecision medicinepredictive markerpredictive modelingprogramsprospectiveprotein biomarkersprotein expressionretention raterural countiesrural underservedruralitysocial health determinantsstroke cognitive outcomestroke patientsuccessunderserved areaurban health disparitiesvascular cognitive impairment and dementia
项目摘要
Vascular cognitive impairment and dementia (VCID) is present in 25-30% of stroke patients, and it is difficult to
predict at the time of stroke who those patients will be. The National Plan to Address Alzheimer’s Disease and
the NHLBI-NINDS VCID Workshop called for increased research on VCID prediction, especially in underserved
populations. The proposed research will identify predictors of cognitive recovery in rural, underserved patients
after mechanical thrombectomy for emergent large vessel occlusion (ELVO) stroke. These predictors will target
patients that would benefit from intensive rehabilitation. Our novel biologic sample registry was used to identify
proteins in systemic blood samples taken during thrombectomy as independent predictors of cognitive
performance at post-stroke discharge and 90-day follow-up. The hypothesis is that these proteins will provide
incremental predictive validity for cognitive impairment including dementia, over and above clinical
characteristics, social determinants of health, and traditional ADRD plasma biomarkers. The proposed study will
prospectively enroll 225 patients collecting systemic arterial blood at the time of thrombectomy and analyze
protein expression. Using a retention strategy tailored to underserved rural participants, neurocognitive test data
and venous blood samples for longitudinal protein expression will be collected from 3 months to 2 years post-
thrombectomy. The study site, located in the US Stroke Belt with some of the most medically underserved rural
counties in the nation, will contribute to the NIH priority focus on health disparities. Specific Aim 1: Test the
hypothesis that increased patient home county rurality predicts worse cognitive outcomes post-stroke,
both acutely and chronically. Generalized estimating equation models will test the main effect of home county
rurality and other social determinants of health on cognitive status (normal, cognitive impairment no dementia,
dementia), the main effect of time on cognitive performance across time points, and the interaction of rurality and
time on cognitive status across time points. Associations among rurality, comorbidities, and time-of-thrombectomy
blood protein expression will be auxiliary analyses. Specific Aim 2: Test the hypothesis that ADRD
biomarkers in systemic blood at time of thrombectomy are biomarkers for acute post-stroke cognitive
impairment and chronic VCID two years later. Blood samples will be assessed for known proteomic
biomarkers for cognition at the UKY Biomarker Center. Specific Aim 3: Test the hypothesis that novel
biomarkers in systemic blood at time of thrombectomy predict chronic VCID including dementia, over
and above the effects of ADRD markers. Proteomic analysis will be conducted on time-of-thrombectomy blood
samples to measure the expression of inflammatory-related proteins. Hierarchical generalized estimating
equation models will assess the incremental improvement in prediction of cognitive status over time added by
these addition markers. Analyses will use LASSO methods and split-sample cross-validation to create a
predictive model based on both ADRD and novel biomarkers that predict cognitive outcomes.
25-30%的脑卒中患者存在血管性认知障碍和痴呆(VCID),并且很难诊断
项目成果
期刊论文数量(0)
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