PROJECT SUMMARY
Stroke is the third leading cause of disability globally, and the number of incident strokes is expected to
increase substantially as the size of the population aged 65 and older grows. After a stroke, some patients
experience an accelerated decline in cognitive and functional ability, while disability stabilizes for other
patients. However, little is known about why cognitive trajectories vary widely after stroke. One theory of
cognitive aging is that a more complex living environment is potentially protective against cognitive decline by
allowing for opportunities for exercise, recreation, and social activities. One way to measure individuals’ living
environments is through studying their life-space, which is the size and pattern of the physical area in which
they spend their time. Studies have found that life-space is associated with better cognitive function in older
adults. However, there is a lack of research in identifying the mechanisms by which life-space is protective
against cognitive decline post-stroke. We will leverage two studies to evaluate the relationship between life-
space and long-term cognitive decline after stroke. Here, we propose a study that aims to (1) estimate the
effects of components of life-space on cognitive decline in the years following stroke in a large observational
cohort from the Cardiovascular Health Study (n=5,888), (2) characterize the life-space of stroke survivors using
geolocation data in the StrokeCog cohort (n=270) and (3) prospectively evaluate the effect of components of
life-space on cognitive change after stroke. Our findings will advance our understanding of factors that affect
the long-term cognitive trajectory after ischemic stroke. This award will also support the career development of
Sylvie Dobrota Lai, a doctoral student in the Department of Epidemiology and Population Health at the
Stanford School of Medicine. Through completing the proposed research, the applicant will pursue training in
(1) the epidemiology of aging, (2) clinical issues in stroke patients, (3) geospatial data collection and analysis,
and (4) career development. The applicant will be supported by a mentorship team comprising of experts in
aging epidemiology, statistics, and neurology. Through this fellowship, the applicant will develop strong
methodological skills, gain subject expertise, and become a more independent epidemiologic researcher. The
proposed study will provide a strong foundation for the applicant’s future academic research career and
position her to become a leader in aging research.