Population Health Research Institute
Stroke/Cognitive Function

Stroke/Cognitive Function
Lessening the burden of cognitive decline

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Epidemiological studies have shown that vascular disease and its risk factors are important determinants of accelerated decline in cognitive and physical functioning. Historically, clinical trials in vascular disease have largely ignored the importance of cognition, physical and functional abilities. The realization that modifiable vascular risk factors (particularly hypertension) play an important role in these clinical disorders presents an exciting opportunity for prevention of premature cognitive and functional decline in the elderly.


Overview

The Stoke and Cognitive Function Program at the Population Health Research Institute aims to understand vascular underpinning for functional cognitive outcomes and examine the best measures of cognitive decline for use in large multi-ethnic, multi-cultural studies. In recent years, investigators at PHRI have expanded their involvement in stroke research.

Epidemiological studies have shown that vascular disease and its risk factors are important determinants of accelerated decline in cognitive and physical functioning. Beyond the effect of overt stroke and myocardial infarction, covert microvascular disease of the brain results in cognitive loss, movement disorders, frailty, depression and premature institutionalization. Historically, clinical trials in vascular disease have largely ignored the importance of cognition, physical and functional abilities. The realization that modifiable vascular risk factors (particularly hypertension) play an important role in these clinical disorders presents an exciting opportunity for prevention of premature cognitive and functional decline in the elderly.  

A key challenge for this area of research is measurement of the constructs and in particular, identifying a simple and efficient composite measure of cognitive, physical and functional decline that is meaningful to patients, clinicians and health services. Our approach has been to refine a concept initially described by Rowe and Kahn as Successful Ageing, that looks beyond the absence of disease, illness or disability to include the ability to function both socially and physically. For the purposes of a clinical outcome measure, we have focused on a construct of health-related Successful Ageing that is relevant to vascular disease. Existing measures of function tend to concentrate on specific areas, for example basic or instrumental activities of daily living, meaning that multiple measures would have to be administered in order to quantify the construct.  We have developed an instrument that measures global functional decline in elderly people at an individual, household and community level. The Standard Assessment of Global activities in the Elderly (SAGE) scale is a simple, cross-cultural,  comprehensive evaluation of functional abilities. It is currently undergoing reliability and validity testing.  The SAGE will be used in future observation studies and clinical trials, to; 1) identify the determinants of premature functional decline (e.g. vascular risk factors, environment, and genetics) and; 2) evaluate interventions (e.g. antihypertensives) to prevent functional decline. In recognition of the importance of subclinical cerebrovascular disease, we arealso engaging in prospective neuroimaging sub-studies within this program of research.


Key Discoveries

The Stroke and Cognition program has developed a measure of functioning in elderly people at an individual, household and community level that examines changes in participation in usual activity. The Standard Asssessment of Global activities in the Elderly (SAGE) scale is a simple, cross-cultural, comprehensive evaluation of functional abilities. The SAGE will be used in future observation studies and clinical trials to:

1. Identify the determinants of premature functional decline (e.g. vascular risk factors, environment, genetics)

2. Evaluate interventions (e.g. antihypertensives) to prevent functional decline. In recognition of the importance of subclinical cerebrovascular disease, we are also engaging in propsective neroimaging sub-studies within this program of research.


Studies


Main Publications

Not available at this time.

 

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Population Health Research Institute • Hamilton, Ontario • information@phri.ca