Rates, risks and routes to reduce vascular dementia (R4vad), a UK-wide multicentre prospective observational cohort study of cognition after stroke: Protocol

Background: Stroke commonly affects cognition and, by definition, much vascular dementia follows stroke. However, there are fundamental limitations in our understanding of vascular cognitive impairment, restricting understanding of prevalence, trajectories, mechanisms, prevention, treatment and patient-service needs. Aims: Rates, Risks and Routes to Reduce Vascular Dementia (R4VaD) is an observational cohort study of post-stroke cognition. We aim to recruit a wide range of patients with stroke, presenting to geographically diverse UK hospitals, into a longitudinal study to determine rates of, and risk factors for, cognitive and related impairments after stroke, to assess potential mechanisms and improve prediction models. Methods: We will recruit at least 2000 patients within six weeks of stroke with or without capacity to consent and collect baseline demographic, clinical, socioeconomic, lifestyle, cognitive, neuropsychiatric and informant data using streamlined patient-centred methods appropriate to the stage after stroke. We will obtain more detailed assessments at four to eight weeks after the baseline assessment and follow-up by phone and post yearly to at least two years. We will assess diagnostic neuroimaging in all and high-sensitivity inflammatory markers, genetics, blood pressure and diffusion tensor imaging in mechanistic sub-studies. Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, UK Department of Neurology, University of Cambridge, Cambridge, UK Department of General Practice, University of Oxford, UK Department of Psychiatry, University of Cambridge, Cambridge, UK National Hospital for Neurology and Neurosurgery, London, UK NHS Foundation Trust and Stroke Research Centre, University College Hospitals, London, UK Institute of Neurology, University College, London, UK Division of Cardiovascular Sciences, School of Medicine, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK King’s College Hospital NHS Foundation Trust, School of Biomedical Engineering and Imaging Sciences, King’s College London, UK Department of Neurology, Lancashire Teaching Hospitals NHS Foundation Trust & Lancaster Medical School, Lancaster University, UK *For details of R4VaD Investigators, see online Appendix. Corresponding author: Joanna M Wardlaw, Centre for Clinical Brain Sciences, Chancellor’s Building, University of Edinburgh, 49 Little France Crescent, Edinburgh