Program Director/Principal Investigator (Last, First, Middle): Woo, Daniel; Anderson, Christopher
3. Project Summary/Abstract
We have recently completed analyses which identifies a population of patients that have a markedly
increased risk of developing dementia/progressive cognitive impairment. Intracerebral hemorrhage patients had
been reported to have a 42% risk of progressive cognitive impairment roughly 3 and a half years after their stroke
and we have found a 39% risk in an independent population of patients. This extraordinarily high rate among
survivors of ICH without a prior history of dementia yields multiple different hypotheses. First, it may be that the
causes of ICH itself are also risk factors for dementia. If so, then those that develop dementia should demonstrate
worsening markers of these causes such as cerebral small vessel disease and cerebral amyloid angiopathy.
However, another prominent hypothesis in the field is that the hemorrhage itself is markedly inflammatory. If this
inflammatory response were to trigger a progressive cognitive decline, then these cases should demonstrate
differential inflammatory gene expression changes.
The Recovery of StrokE (NS100417) study has recruited 163 cases out of a planned 500 total cases of ICH
including 3T MRI, baseline and 3 month samples for DNA, RNA-sequencing and detailed baseline, 3 and 6
month motor, cognitive, behavioral and functional examinations. The current proposal seeks to re-enroll 250
cases of the planned 500 for 12 to 24 month follow-up neuroimaging, RNA sampling and repeated examination
measures to address the following aims: 1) Determine if progressive cognitive impairment correlates with an
increase in markers of cerebral small vessel disease and cerebral amyloid angiopathy; 2) Determine if
inflammation as measured by RNA-sequencing markers of inflammation correlates with progressive cognitive
impairment and 3) identify novel neuroimaging markers associated with progressive cognitive decline.
If successful, we will provide the largest longitudinal multiple assessment evaluation of ICH and answer the
major hypotheses on the development of dementia among survivors of ICH.
PHS 398/2590 (Rev. 06/09) Page Continuation Format Page