Up to one-third of stroke survivors go on to develop dementia and cognitive impairment. And in rural Appalachia, the numbers are even higher. But is it possible to predict, at the time of a stroke, who will have the best cognitive recovery?
That’s a question that University of Kentucky neuropsychologist Jordan Harp, PhD, associate professor of neurology, hopes to answer as principal investigator of a study that is looking at biomarkers and neurocognitive test data for clues.
“Kentucky is in the stroke belt, where there is a much higher rate of stroke than the rest of the country,” Dr. Harp said. “Many of these patients have vascular changes in the white matter of the brain, but we aren’t really getting the early picture of white matter disease. Our end goal here is to find a telling signature.”
If researchers are better able to predict outcomes, early and aggressive treatment may help mitigate or prevent the damage, he added.
In ischemic strokes where a clot is blocking a large vessel, Kentucky Neuroscience Institute neurointerventionalists perform an emergency procedure called a mechanical thrombectomy, which physically captures the clot inside the vessel, removes it and restores blood flow to the affected brain areas.
The INDICATE study — Investigating Neuromarkers of Decline in Cognition After Thrombectomy for ELVO (Emergent Large Vessel Occlusion) — involves drawing arterial blood during the mechanical thrombectomy and performing follow-up venous blood draws and cognitive testing at three months, six months, one year and two years post-procedure.
It builds upon work done in the parent BACTRAC study — Blood And Clot Thrombectomy Registry And Collaboration, under the direction of key faculty that included Harp, pharmacologist Keith Pennypacker, PhD, neurosurgeon and PI of BACTRAC Justin Fraser, MD, and biostatistician Chris McLouth, PhD. The work is being done through the Center for Advanced Translational Stroke Science.
Making INDICATE even more important for Kentucky is that it will enroll rural and Appalachian patients, who face unique health disparities and environmental concerns. Dr. Harp’s other research includes numerous studies on aging, Alzheimer’s and cognitive degeneration, as well as dementia in the Down syndrome population.