Identification and Care of Patients at Risk of Post-Stroke Dementia
Award Number
DRF-2015-08-006Award Type
Doctoral Research FellowshipProgramme
NIHR FellowshipsStatus / Stage
CompletedDates
2 October 2015 -1 October 2020
Duration (calculated)
04 years 11 monthsFunder(s)
NIHRFunding Amount
£237,793.92Funder/Grant study page
NIHRContracted Centre
University of Newcastle upon TyneContracted Centre Webpage
Principal Investigator
Dr Eugene TangPI Contact
e.y.h.tang@newcastle.ac.ukWHO Catergories
Development of clinical assessment of cognition and functionUnderstanding risk factors
Disease Type
Post-Stroke-DementiaCPEC Review Info
| Reference ID | 73 |
|---|---|
| Researcher | Reside Team |
| Published | 12/06/2023 |
Data
| Award Number | DRF-2015-08-006 |
|---|---|
| Status / Stage | Completed |
| Start Date | 20151002 |
| End Date | 20201001 |
| Duration (calculated) | 04 years 11 months |
| Funder/Grant study page | NIHR |
| Contracted Centre | University of Newcastle upon Tyne |
| Contracted Centre Webpage | |
| Funding Amount | £237,793.92 |
Abstract
Stroke and dementia are closely linked; like stroke, the most common types of dementia are more common in people with high vascular risk. In the year after a stroke, one in ten people can develop dementia; this is called post-stroke dementia (PSD). National standards define the initial specialist care for stroke-survivors; six months post stroke, patients are usually returned to the care of their General Practitioner (GP). Primary care follow up involves yearly check-ups, via the Quality and Outcomes Framework standards, focused mainly on management of individual risk factors. In England, a policy emphasis on improving dementia care has led to the introduction of memory assessment in people at high risk; one group is stroke-survivors over 60 years. Generally there is no agreed formal process in specialist stroke services to identify which stroke patients are at the greatest risk of developing dementia. There is also no single accurate and practical risk assessment tool for health professionals to use. This is in contrast to heart disease, where electronic tools such as QRISK2, enable clinicians to combine variables to calculate an individual’s future risk of disease. This allows better planning of care for those at increased risk. The programme utilises mixed methodology with 3 separate but interlinked work-phases.Phase 1 (Descriptive/qualitative study): Data from the cognitive difficulties section of the Sentinel Stroke National Audit Programme will be collated from eight local stroke service providers. Semi-structured interviews will be conducted with health professionals (stroke and primary care) and with a range of stroke-survivors and their carers to explore their current care experiences. Themes and identified gaps in clinical care will be used to develop material for the electronic Delphi study (phase three). Phase 2 (Secondary analysis of cohort data): National and International longitudinal cohort datasets will be harmonised and stroke-survivors will be identified from this dataset. Existing dementia risk models will then be validated and accuracy assessed. The accuracy with additional (and/or removal) of variables in existing models will also be assessed. The most accurate model in predicting dementia in stroke-survivors will then be brought into phase three. Phase3 (Delphi Study): Phase 1 and 2 findings will be used to inform a modified three round electronic Delphi survey with primary and secondary care experts. Consensus will be sought on the essential components of a dedicated clinical service and if a risk prediction model should be used. Benefits to Patients and the NHS I aim to develop a dedicated clinical pathway, incorporating an objective risk assessment tool, to identify stroke-survivors at greatest risk of future dementia. This will promote the use of secondary prevention strategies and timely access to information and treatments.
Aims
The aim of my research is to critically review the care received by people who have had a stroke and are at high risk of dementia through: i) Describing current care provision from the perspectives of patients, carers and key professionals ii) Developing and exploring the use of risk prediction tools to identify those most at risk and iii) Seeking the views of professionals on the key findings from i) and ii) with a view to improving future care through the development of an integrated clinical pathwaySpecific objectives include: Describe the current care experience of stroke-survivors with cognitive difficulties and the views and experiences of primary and secondary care professionals providing their care (Phase 1) Validate the accuracy of risk prediction models for dementia in stroke survivors (Phase 2) Seek consensus expert opinion on findings from phases 1 and 2 on how to improve the management of these individuals in the future (Phase 3) Plan of Investigation