A longitudinal study of the post-stroke immune response and cognitive functioning: the StrokeCog study protocol
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A longitudinal study of the post-stroke immune response and cognitive functioning: the StrokeCog study protocol Lauren L. Drag1* , Michael Mlynash1, Huda Nassar2, Elizabeth Osborn1, Da E. Kim1, Martin S. Angst2, Nima Aghaeepour2, Marion Buckwalter1,3 and Maarten G. Lansberg1
Abstract Background: Stroke increases the risk of cognitive impairment even several years after the stroke event. The exact mechanisms of post-stroke cognitive decline are unclear, but the immunological response to stroke might play a role. The aims of the StrokeCog study are to examine the associations between immunological responses and longterm post-stroke cognitive trajectories in individuals with ischemic stroke. Methods: StrokeCog is a single-center, prospective, observational, cohort study. Starting 6–12 months after stroke, comprehensive neuropsychological assessment, plasma and serum, and psychosocial variables will be collected at up to 4 annual visits. Single cell sequencing of peripheral blood monocytes and plasma proteomics will be conducted. The primary outcome will be the change in global and domain-specific neuropsychological performance across annual evaluations. To explain the differences in cognitive change amongst participants, we will examine the relationships between comprehensive immunological measures and these cognitive trajectories. It is anticipated that 210 participants will be enrolled during the first 3 years of this 4-year study. Accounting for attrition, an anticipated final sample size of 158 participants with an average of 3 annual study visits will be available at the completion of the study. Power analyses indicate that this sample size will provide 90% power to detect an average cognitive change of at least 0.23 standard deviations in either direction. Discussion: StrokeCog will provide novel insight into the relationships between immune events and cognitive change late after stroke. Keywords: Stroke, Cognition, Proteomics, Vascular dementia, Neuropsychology, Immune system
Background Approximately 800,000 individuals in the United States sustain a stroke each year [1]. It is well-known that stroke can be associated with acute cognitive effects, for which some degree of recovery is to be expected. Despite this initial recovery, cognitive impairment occurs at a high frequency, persisting well past the subacute * Correspondence: [email protected] 1 Department of Neurology and Neurological Sciences, Stanford University Medical Center, 213 Quarry Rd, Palo Alto, CA 94305, USA Full list of author information is available at the end of the article
recovery period [2, 3]. Stroke places some individuals at risk of an increased rate of cognitive decline, even several years after stroke, and a history of stroke approximately doubles the long-term risk of incident dementia [2, 4–8]. The pathophysiology underlying post-stroke cognitive decline (and particularly late incident dementia) is not well understood. Some factors have been identified that are associated with increased ris
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