Influence of Vision Impairments on Dementia in Stroke Survivors: A Longitudinal Analysis

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PROJECT SUMMARY/ ABSTRACT This is an application for a K01 Mentored Research Scientific Development Award. The goal of the proposed project is to provide the candidate with the advanced skills needed to establish an independent research program examining the visual health needs of stroke survivors also living with dementia. To facilitate this long-term goal, the candidate proposes a comprehensive training plan, combining formal coursework and meetings overseen by her mentors, participation in applied training experiences and involvement in seminars and workshops. Specific training goals include: (1) gain advanced knowledge in the epidemiology and mechanisms of post-stroke dementia, (2) learn neuropsychological and clinical assessment of dementia, (3) acquire skills and training in clinical research methodology and statistical analysis, using both cross sectional and longitudinal data and (4) productively participate in career advancement and leadership development activities. The training plan will be executed in coordination with the set of research activities mentioned above, which are based on preliminary data collected by the applicant. The preliminary data show a lack of research on whether the presence of specific types of vision impairment and ocular deficits increase the risk of post-stroke dementia. The candidate will expand on these findings by using data from the Atherosclerosis Risk in Communities stroke cohort to complete the following aims: (1) characterize the prevalence and outcomes associated with vision impairment(s) among stroke survivors with and without dementia; (2) determine how pre-existing vision impairments impact the development of dementia, among those with stroke; and (3) determine the effect and downstream consequences of post-stroke vision impairment in persons without pre-existing vision impairment. The primary hypotheses include that: (1) the odds of developing dementia are higher for stroke survivors with pre-existing vision impairment, compared to stroke survivors with normal vision; (2) stroke survivors with vision impairment preceding the stroke are more likely to develop dementia earlier, compared to stroke survivors with normal vision; and (3) the impact of post-stroke vision impairment on dementia development is stronger for those with functional impairment, compared to those without functional impairment. The expected findings will provide critical insight into the types of vision impairment and ocular deficits experienced by people with post-stroke dementia, including more information on the significance of distinguishing between pre- and post-stroke visual impairments and the expected differential impact on dementia. Results from this research will be used to develop a subsequent R01 research proposal that will facilitate the candidate’s transition into an independent researcher focused on analysis of existent data and prospective enrollment to optimize the independence and community participation of stroke survivors with vision impairments and dementia.