- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05885295
The Imperial Comprehensive Cognitive Assessment in Cerebrovascular Disease (IC3) (IC3)
Understanding Factors Affecting Cognitive Function in Cerebrovascular Disease
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Aims and objectives
Develop an adaptive, scalable, self-administered, digital comprehensive cognitive screening tool to detect cognitive impairments in patients with cerebrovascular disease. The IC3 will:
I. Detect both domain-general (e.g. executive function) and domain-specific (e.g. aphasia, apraxia, neglect) deficits post-stroke.
II. Allow monitoring to occur at scale, in a cost-efficient manner, as test administration can occur independent of trained professionals.
III. Minimise the effects of neglect or aphasia on cognitive assessments. IV. Have high test-re-test reliability for repeated-testing longitudinally.
- Validate the IC3 against commonly used cognitive screening tools.
- Apply the IC3 in a cohort of stroke survivors, as part of the main study, to map their trajectory of cognitive impairment over the course of the first year after stroke.
- Identify novel biomarkers of cognitive outcome (cognitive scores at 1 year) and recovery trajectory through the main study using:
I. Premorbid demographics, and comorbid physical, neuropsychological and socioeconomic factors II. Structural and functional MRI brain imaging, to assess metrics of cerebrovascular disease load, stroke lesion topology and brain network dynamics.
III. Blood biomarkers of neurodegeneration (total microtubule-associated protein TAU; Phosphorylated TAU isoforms; Amyloid Aβ42/40 ratio) and neuroaxonal injury (Neurofilament Light - NFL; Glial Fibrillary Acidic protein - GFAP). The study will characterise the time course of the blood biomarkers over the first year after acute stroke and relate these to MRI measures of axonal injury and brain atrophy, as well as cognitive and functional outcomes at 12 months.
IC3 Assessment Design and Development
Cognitive tests. The IC3 assessment covers 22 short tasks, spanning a wide range of cognitive domains followed by several clinically-validated questionnaires, designed to be completed in under 60-70 minutes. IC3 is available via a web-browser on any modern device (smartphone, tablet, computer/laptop). To launch the assessment, the participant clicks on a link created by the study team.
The digital nature of the IC3 affords scalability in cognitive monitoring by being usable in both the clinical setting and home environment in the absence of a trained clinician. As well as reducing healthcare costs, this feature promotes accessibility of the assessment for physically disabled patients in whom attendance to healthcare or research setting is difficult. Compared to pen and paper tests, the IC3 test administration is standardised, scoring is automated and more detailed response metrics per individual tests are collected (e.g. capturing reaction time and trial-by-trial variability in responses, as well as accuracy). This allows real-time evaluation of cognitive impairments against normative samples of age-, education- and sex- matched controls.
Demographic and neuropsychiatric questionnaires. A number of health questionnaires and modified versions of relevant clinically-validated questionnaires are completed by the patient or carers to assess mood, apathy, fatigue and sleep.
At the end of the assessment the participant will be given a graphical, easy-to-understand diagram that highlights their performance against normative data. The normative data will be based on single time-point data collected remotely from large sample of healthy controls (>3000).
Main IC3 study design
This prospective observational longitudinal study aims to recruit 300 patients with acute stroke and obtain repeated measures of cognition and psychosocial status at baseline, 3-months, 6-months and 12-months post ictus. IC3 is currently a single-site study at Imperial College Healthcare NHS Trust, England, and commenced recruitment in 2022. In addition to the cognitive monitoring, all patients will be invited to take part in MRI brain imaging and blood biomarker sub-studies.
IC3 validation sub-study. A minimum of 100 patients will undergo clinically validated pen and paper cognitive screens. Test-retest reliability analyses will estimate the impact of learning effects on performance, and compare remote administration with in-person delivery of the assessment.
MRI sub-study. Clinically acquired brain imaging at the time of the acute stroke (including FLAIR and DWI sequences) will be obtained. All 300 patients will be invited to undergo additional brain MRI imaging at 3 and 12 months using a Siemens Verio 3T scanner at the Imperial College Clinical Imaging Facility. MRI measures will be used as prognostic indicators for cognitive trajectory.
Blood biomarkers sub-study. Blood samples will be obtained at baseline, and at 3, 6 and 12 months from 200 patients. Two EDTA (plasma) and two SST (serum) samples will be collected. Sample processing involves centrifugation at 2000g for 10 minutes at 4°C, followed by secure storage at -80°C. Additional single PAXgene sample will be collected at one time point for DNA storage for future analysis. The primary plasma biomarker of interest will be NFL. Additional markers including GFAP, total TAU, phosphorylated TAU and Amyloid Aβ42/40 ratio will be quantified. Testing will be performed at University College London via a digital ELISA technique, using a Quanterix Simoa analyser to provide ultrasensitive assessment of concentrations.
Study Population
Participant identification, recruitment and consent. Patients will be recruited from the Imperial College Healthcare NHS Trust by study personnel and the clinical team. Our goal is to recruit patients as early after stroke as is practical, and ideally within ten days to facilitate acute blood biomarker assessment. Those satisfying the inclusion and exclusion criteria will be approached and consented. If a patient is unable to provide fully informed consent, for example due to severe aphasia, we will assent with permission from a consultee. Patients that have been assented will be reconsented if they are subsequently able to provide full informed consent. The consent procedure will be carried out in strict compliance with national legislation and General Data Protection Regulation. Control participants will be aged > 18 and without history of neurological illness or serious psychiatric illness.
Study Type
Enrollment (Estimated)
Contacts and Locations
Study Locations
-
-
-
London, United Kingdom, W12 0NN
- Recruiting
- Imperial College London
-
Contact:
- Fatemeh Geranmayeh, PhD
- Phone Number: 020 7594 1064
- Email: fatemeh.geranmayeh00@imperial.ac.uk
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Sampling Method
Study Population
Description
Inclusion Criteria:
- Aged > 18
- Evidence of confirmed stroke (for patients)
- Ability to concentrate for 15 minutes at a time to engage with cognitive testing
Exclusion Criteria for the main study:
- Pre-stroke diagnosis of dementia
- Severe visuo-spatial problems, fatigue, or mental health problems
- Severe hearing impairment in the presence of reading comprehension impairment
Exclusion Criteria for the MRI imaging sub-study:
- Pregnancy
- Presence of metal implants
- Claustrophobia
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Patient
Patient with stroke
|
observational study examining cognition post stroke using behavioural tests, MRI brain and blood tests
|
Controls
Age-matched controls
|
observational study examining cognition post stroke using behavioural tests, MRI brain and blood tests
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
cognition
Time Frame: 1 year after stroke
|
IC3-derived accuracy measures on cognitive testing Scale title: The Imperial Comprehensive Cognitive Assessment in Cerebrovascular Disease Impairment value defined as <1.5 Standard Deviation Units below the age and education -matched control sample Lower values mean worse outcome
|
1 year after stroke
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
MOCA
Time Frame: 1 year post stroke
|
Clinically derived MOCA scores for cognition Scale title: The Montreal Cognitive Assessment Range 0-30.
Lower values mean worse outcome.
|
1 year post stroke
|
NIHSS
Time Frame: 1 year post stroke
|
NIH Stroke Scale Scale title: National Institute of Health Stroke Scale Range: 0-24 Lower values mean better outcome.
|
1 year post stroke
|
Lawton and Brody Instrumental activities of daily living (IADL)
Time Frame: 1 year post stroke
|
Scale title: Lawton and Brody Instrumental Activities of Daily Living Source: Lawton, M.P., and Brody, E.M. "Assessment living." Gerontologist 9:179-186, (1969). Range: 0-8 Lower values mean worse outcome. |
1 year post stroke
|
MRS
Time Frame: 1 year post stroke
|
Scale title: Modified Rankin Scale Range: 0-6 Lower values mean better outcome.
|
1 year post stroke
|
Collaborators and Investigators
Sponsor
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Mental Disorders
- Cardiovascular Diseases
- Vascular Diseases
- Brain Diseases
- Central Nervous System Diseases
- Nervous System Diseases
- Arteriosclerosis
- Arterial Occlusive Diseases
- Neurocognitive Disorders
- Cognition Disorders
- Intracranial Arterial Diseases
- Intracranial Arteriosclerosis
- Leukoencephalopathies
- Stroke
- Dementia
- Cognitive Dysfunction
- Dementia, Vascular
- Cerebrovascular Disorders
- Cerebral Small Vessel Diseases
Other Study ID Numbers
- RGIT / R&D REF: 21HH7075
- MRC (Other Grant/Funding Number: P79100)
- 299333 (Other Identifier: IRAS)
- CPMS 50479 (Registry Identifier: UK CRN)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Stroke
-
University Hospital, GhentRecruitingStroke | Stroke, Ischemic | Stroke, Acute | Stroke Sequelae | Stroke HemorrhagicBelgium
-
Moleac Pte Ltd.RecruitingStroke | Stroke, Ischemic | Stroke Sequelae | Stroke, Cardiovascular | Strokes Thrombotic | Stroke, Embolic | Stroke, CryptogenicSingapore, Philippines
-
Moleac Pte Ltd.Not yet recruitingStroke | Stroke, Ischemic | Stroke Sequelae | Stroke, Cardiovascular | Strokes Thrombotic | Stroke, Embolic | Stroke, Cryptogenic
-
IRCCS San Camillo, Venezia, ItalyRecruitingStroke | Stroke, Ischemic | Stroke Sequelae | Stroke HemorrhagicItaly
-
Vanderbilt University Medical CenterPatient-Centered Outcomes Research Institute; University of Alabama at BirminghamEnrolling by invitationStroke | Stroke, Ischemic | Stroke, Acute | Stroke Sequelae | Engagement, Patient | Stroke HemorrhagicUnited States
-
University of MinnesotaAmerican Occupational Therapy FoundationRecruitingStroke | Stroke Sequelae | Stroke Hemorrhagic | Stroke IschemicUnited States
-
University of British ColumbiaCanadian Institutes of Health Research (CIHR); Michael Smith Foundation for...RecruitingStroke | Stroke, Ischemic | Stroke Hemorrhagic | Chronic StrokeCanada
-
University of CincinnatiMedical University of South Carolina; University of California, Los Angeles; University...RecruitingStroke | Stroke, Ischemic | Stroke, Acute | Stroke HemorrhagicUnited States
-
Turkish Stroke Research and Clinical Trials NetworkElectroCore INC; Turkish Neurological SocietyCompletedStroke | Stroke, Ischemic | Stroke, Acute | Stroke, HemorrhagicTurkey
-
University of LiegeCompletedStroke, Acute | Stroke Hemorrhagic | Stroke, ComplicationBelgium
Clinical Trials on MRI brain, Blood tests, cognitive assessments
-
West China HospitalRigshospitalet, Denmark; St Thomas' Hospital, LondonNot yet recruitingBrain Diseases | Aortic Valve Stenosis
-
University Hospital, MontpellierRecruiting
-
Massachusetts General HospitalCompletedTraumatic Brain Injury | Blast InjuriesUnited States
-
University Hospital, CaenUnknown
-
Nottingham University Hospitals NHS TrustRecruitingDementia (Diagnosis)United Kingdom
-
Assistance Publique Hopitaux De MarseilleNot yet recruitingStress Disorders, Post-Traumatic | Depressive Disorder, Major | Anxiety DisorderFrance
-
University Hospital, AngersCompletedPresymptomatic Huntington DiseaseFrance
-
Abbott Point of CareUnited States Department of Defense; University of California, San FranciscoActive, not recruiting
-
Children's Hospital Medical Center, CincinnatiNational Heart, Lung, and Blood Institute (NHLBI)CompletedHeart Disease CongenitalUnited States