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Pattern and Rate of Cognitive Decline in Cerebral Small Vessel Disease: A Prospective Study.

Lawrence, AJ; Brookes, RL; Zeestraten, EA; Barrick, TR; Morris, RG; Markus, HS (2015) Pattern and Rate of Cognitive Decline in Cerebral Small Vessel Disease: A Prospective Study. PLoS One, 10 (8). e0135523. ISSN 1932-6203 https://doi.org/10.1371/journal.pone.0135523
SGUL Authors: Barrick, Thomas Richard Lawrence, Andrew John

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Abstract

OBJECTIVES: Cognitive impairment, predominantly affecting processing speed and executive function, is an important consequence of cerebral small vessel disease (SVD). To date, few longitudinal studies of cognition in SVD have been conducted. We determined the pattern and rate of cognitive decline in SVD and used the results to determine sample size calculations for clinical trials of interventions reducing cognitive decline. METHODS: 121 patients with MRI confirmed lacunar stroke and leukoaraiosis were enrolled into the prospective St George's Cognition And Neuroimaging in Stroke (SCANS) study. Patients attended one baseline and three annual cognitive assessments providing 36 month follow-up data. Neuropsychological assessment comprised a battery of tests assessing working memory, long-term (episodic) memory, processing speed and executive function. We calculated annualized change in cognition for the 98 patients who completed at least two time-points. RESULTS: Task performance was heterogeneous, but significant cognitive decline was found for the executive function index (p<0.007). Working memory and processing speed decreased numerically, but not significantly. The executive function composite score would require the smallest samples sizes for a treatment trial with an aim of halting decline, but this would still require over 2,000 patients per arm to detect a 30% difference with power of 0.8 over a three year follow-up. CONCLUSIONS: The pattern of cognitive decline seen in SVD over three years is consistent with the pattern of impairments at baseline. Rates of decline were slow and sample sizes would need to be large for clinical trials aimed at halting decline beyond initial diagnosis using cognitive scores as an outcome measure. This emphasizes the importance of more sensitive surrogate markers in this disease.

Item Type: Article
Additional Information: © 2015 Lawrence et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Keywords: Aged, Cerebral Small Vessel Diseases, Cognition, Cognition Disorders, Female, Humans, Longitudinal Studies, Male, Memory, Short-Term, Middle Aged, Neuropsychological Tests, Prospective Studies, Humans, Longitudinal Studies, Prospective Studies, Cognition, Memory, Short-Term, Cognition Disorders, Neuropsychological Tests, Aged, Middle Aged, Female, Male, Cerebral Small Vessel Diseases, General Science & Technology, MD Multidisciplinary
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) > Neuroscience (INCCNS)
Journal or Publication Title: PLoS One
ISSN: 1932-6203
Language: eng
Dates:
DateEvent
14 August 2015Published
22 July 2015Accepted
Publisher License: Creative Commons: Attribution 4.0
Projects:
Project IDFunderFunder ID
081589Wellcome Trusthttp://dx.doi.org/10.13039/100004440
ARUK-PG2013-2Alzheimer's Research UKUNSPECIFIED
PubMed ID: 26273828
Web of Science ID: WOS:000359493600072
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/107887
Publisher's version: https://doi.org/10.1371/journal.pone.0135523

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