Title: Apathy in stroke and cerebral small vessel disease- towards better understanding and more effective treatment approaches
Funder: Stroke Association

Abstract: Lay title: Understanding the importance of apathy, and improving its care in patients with stroke LAY: Cerebral small vessel disease describes a disorder of the small blood vessels in the brain, which is usually associated with high blood pressure. It causes 20% of all strokes (lacunar stroke) and is the main cause of cognitive changes and dementia associated with stroke. In addition, behavioural symptoms such as depression and apathy are common in patients with SVD. Apathy describes a loss of initiative, a failure to engage in normal activities and a lack of emotional reactivity. Apathy has a major effect of quality of life for a SVD sufferer; we have shown that for the patient it is more important in determining quality of life than is disability, such as weakness, from the stroke itself. It is also very distressing for the family/carer. Despite its importance it is poorly understood, and there are few treatment options which have been shown to work. We will bring together a multidisciplinary team (stroke physicians/neurologists, cognitive neuroscientists, clinical neuropsychologists, brain imagers and physiotherapists) to address this area. An additional component will be to build capacity through two multidisciplinary PhD studentships. Components of the programme will be: 1. Determining how common apathy is and whether the presence of apathy predicts long term decline in cognition, functional status, disability and quality of life. 2. A study using MRI brain imaging to look at which areas of the brain are affected in patients who suffer apathy in SVD to help us understand the underlying mechanisms. SCIENTIFIC: Apathy is common feature of cerebral small vessel disease (SVD). In this programme we will perform. (1) A Systematic review of apathy in stroke and SVD determining its relationship to outcome, and reviewing potential treatment options including drawing knowledge from other neurological conditions (2). Analysis of longitudinal follow-up data from a large existing cohort of patients with MRI confirmed SVD (RUN-DMC cohort (n=503)) to determine whether apathy in patients with SVD predicts cognitive and functional decline, increased disability, reduced quality of life, and increased caregiver burden (3). Use of two existing prospective studies in SVD, which have collected DTI MRI and cognitive data (SCANS and RUN-DMC) to determine the pattern of damage to white matter tracts from SVD, and identify the underlying neural substrate (4). In a new collection of 200 patients with all subtypes of stroke to determine whether apathy is associated with poorer functional outcome, and this association is mediated by SVD as quantified on MRI by extent of leukoaraiosis (5). In pilot studies explore therapeutic aspects including whether apathy predicts a poor response to anti-depressant therapy in patients being treated for depression, and whether alternative approaches such as the use of dopaminerigic drugs may be more effective.

Lay abstract: Lay title: Understanding the importance of apathy, and improving its care in patients with stroke LAY: Cerebral small vessel disease describes a disorder of the small blood vessels in the brain, which is usually associated with high blood pressure. It causes 20% of all strokes (lacunar stroke) and is the main cause of cognitive changes and dementia associated with stroke. In addition, behavioural symptoms such as depression and apathy are common in patients with SVD. Apathy describes a loss of initiative, a failure to engage in normal activities and a lack of emotional reactivity. Apathy has a major effect of quality of life for a SVD sufferer; we have shown that for the patient it is more important in determining quality of life than is disability, such as weakness, from the stroke itself. It is also very distressing for the family/carer. Despite its importance it is poorly understood, and there are few treatment options which have been shown to work. We will bring together a multidisciplinary team (stroke physicians/neurologists, cognitive neuroscientists, clinical neuropsychologists, brain imagers and physiotherapists) to address this area. An additional component will be to build capacity through two multidisciplinary PhD studentships. Components of the programme will be: 1. Determining how common apathy is and whether the presence of apathy predicts long term decline in cognition, functional status, disability and quality of life. 2. A study using MRI brain imaging to look at which areas of the brain are affected in patients who suffer apathy in SVD to help us understand the underlying mechanisms. SCIENTIFIC: Apathy is common feature of cerebral small vessel disease (SVD). In this programme we will perform. (1) A Systematic review of apathy in stroke and SVD determining its relationship to outcome, and reviewing potential treatment options including drawing knowledge from other neurological conditions (2). Analysis of longitudinal follow-up data from a large existing cohort of patients with MRI confirmed SVD (RUN-DMC cohort (n=503)) to determine whether apathy in patients with SVD predicts cognitive and functional decline, increased disability, reduced quality of life, and increased caregiver burden (3). Use of two existing prospective studies in SVD, which have collected DTI MRI and cognitive data (SCANS and RUN-DMC) to determine the pattern of damage to white matter tracts from SVD, and identify the underlying neural substrate (4). In a new collection of 200 patients with all subtypes of stroke to determine whether apathy is associated with poorer functional outcome, and this association is mediated by SVD as quantified on MRI by extent of leukoaraiosis (5). In pilot studies explore therapeutic aspects including whether apathy predicts a poor response to anti-depressant therapy in patients being treated for depression, and whether alternative approaches such as the use of dopaminerigic drugs may be more effective.

Research activity codes: 2.1 BIOLOGICAL AND ENDOGENOUS FACTORS;2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS
Health categories: STROKE;MENTAL HEALTH