A Role for New Brain Magnetic Resonance Imaging Modalities in Daily Clinical Practice: Protocol of the Prediction of Cognitive Recovery After Stroke (PROCRAS) Study

Hugo P Aben; Yael D Reijmer; Johanna Ma Visser-Meily; Jacoba M Spikman; Jeroen de Bresser; Geert Jan Biessels; Paul Lm de Kort

doi:10.2196/resprot.9431

A Role for New Brain Magnetic Resonance Imaging Modalities in Daily Clinical Practice: Protocol of the Prediction of Cognitive Recovery After Stroke (PROCRAS) Study

JMIR Res Protoc. 2018 May 28;7(5):e127. doi: 10.2196/resprot.9431.

Authors

Hugo P Aben^{1

2}, Yael D Reijmer², Johanna Ma Visser-Meily³, Jacoba M Spikman⁴, Jeroen de Bresser^{5

6}, Geert Jan Biessels², Paul Lm de Kort¹

Affiliations

¹ Elisabeth Tweesteden Hospital, Department of Neurology, Tilburg, Netherlands.
² Brain Center Rudolf Magnus, Department of Neurology, University Medical Center Utrecht, Utrecht, Netherlands.
³ Physical Therapy Science & Sports, Brain Center Rudolf Magnus, Department of Rehabilitation, University Medical Center Utrecht, Utrecht, Netherlands.
⁴ Department of Clinical and Experimental Neuropsychology, University of Groningen, Groningen, Netherlands.
⁵ Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands.
⁶ Department of Radiology, Leiden University Medical Center, Leiden, Netherlands.

Abstract

Background: Cognitive impairment is common after acute ischemic stroke, affecting up to 75% of the patients. About half of the patients will show recovery, whereas the others will remain cognitively impaired or deteriorate. It is difficult to predict these different cognitive outcomes.

Objective: The objective of this study is to investigate whether diffusion tensor imaging-based measures of brain connectivity predict cognitive recovery after 1 year, in addition to patient characteristics and stroke severity. A specific premise of the Prediction of Cognitive Recovery After Stroke (PROCRAS) study is that it is conducted in a daily practice setting.

Methods: The PROCRAS study is a prospective, mono-center cohort study conducted in a large teaching hospital in the Netherlands. A total of 350 patients suffering from an ischemic stroke who screen positive for cognitive impairment on the Montreal Cognitive Assessment (MoCA<26) in the acute stage will undergo a 3Tesla-Magnetic Resonance Imaging (3T-MRI) with a diffusion-weighted sequence and a neuropsychological assessment. Patients will be classified as being unimpaired, as having a mild vascular cognitive disorder, or as having a major vascular cognitive disorder. One year after stroke, patients will undergo follow-up neuropsychological assessment. The primary endpoint is recovery of cognitive function 1 year after stroke in patients with a confirmed poststroke cognitive disorder. The secondary endpoint is deterioration of cognitive function in the first year after stroke.

Results: The study is already ongoing for 1.5 years, and thus far, 252 patients have provided written informed consent. Final results are expected in June 2019.

Conclusions: The PROCRAS study will show the additional predictive value of diffusion tensor imaging-based measures of brain connectivity for cognitive outcome at 1 year in patients with a poststroke cognitive disorder in a daily clinical practice setting.

Registered report identifier: RR1-10.2196/9431.

Keywords: anisotropy; brain infarction; cognitive dysfunction; diffusion magnetic resonance imaging; diffusion tensor imaging; stroke.

©Hugo P Aben, Yael D Reijmer, Johanna MA Visser-Meily, Jacoba M Spikman, Jeroen de Bresser, Geert Jan Biessels, Paul LM de Kort. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 28.05.2018.