With population aging and improved stroke survival, the rates of post stroke cognitive decline (PSCD) are increasing. PSCD is associated with adverse health outcomes, increased health costs, and poorer quality of life. There is significant variability in which stroke patients develop PSCD. Many factors likely drive this variability, including age at stroke, time from stroke onset, stroke features, socio-demographics, geography, health conditions, behaviors and medical care factors. Yet, PSCD remains poorly understood. The long-term goal of this career development award is to promote the candidate's development into a leader and independently funded physician-scientist in PSCD among older adults.
The aims of this project are: 1) To determine the impact of stroke on cognitive function, both in the short-term and the long-term;2) To determine the socio-demographic, geographic, medical, and behavioral predictors of PSCD;3) To assess whether blood pressure or anti-hypertensive medication adherence are associated with cognitive function in stroke survivors using primary and secondary data. This project will combine data from 2 leading prospective stroke cohort studies in the US: 1) a large, geographically dispersed, race- and gender-balanced cohort of middle-aged and older adults being followed for stroke and cognitive decline and with premorbid and post stroke cognitive assessments, and 2) a population-based stroke surveillance project in a bi-ethnic community with immediate post stroke cognitive assessments. Both cohort studies have cognitive measures sensitive to PSCD and data on stroke features. This research will generate knowledge by better identifying potential mechanisms of PSCD and will assist in planning interventions to improve the care and prevention of stroke and PSCD. This research ultimately will lead to greater understanding of PSCD, better treatments, and better outcomes in older people. The candidate, Dr. Deborah Levine, who will focus her research on the growing population of stroke survivors, will pursue a mentored research plan designed to enhance her skills in the methods needed to study PSCD. A detailed career development plan will promote the candidate's development of expertise in four areas: 1) the analysis and conduct of longitudinal epidemiologic studies of older adults;2) the measurement of cognitive outcomes;3) patient treatment adherence and chronic illness interventions;and 4) geriatrics and stroke care. The career development plan consists of a multidisciplinary team of experienced mentors and advisors who will oversee a range of formal coursework and practical experiences in these areas to ensure the candidate's future success. Exceptional resources of a top university and a mentoring team with proven success in developing junior physician-scientists in these topic areas makes the University of Michigan an ideal environment for this project.

Public Health Relevance

One in three individuals will experience dementia, a stroke, or both during their lifetime. A key question for this new century is: In this era of population aging and improved stroke survival, how can cognitive disability from stroke be reduced or delayed? To begin to confront this problem, we will establish a research program to study the epidemiology of post stroke cognitive decline and to identify risk factors that may be targets for future intervention studies. Reducing post stroke cognitive decline will be important to decrease the risk and population burden of stroke and dementia. Information from this study will better identify potential mechanisms of post stroke cognitive decline and may assist in planning interventions to reduce or prevent post stroke cognitive decline in older adults.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Mentored Patient-Oriented Research Career Development Award (K23)
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National Institute on Aging Initial Review Group (NIA)
Program Officer
Petanceska, Suzana
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University of Michigan Ann Arbor
Internal Medicine/Medicine
Schools of Medicine
Ann Arbor
United States
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Ankuda, Claire K; Levine, Deborah A (2016) Trends in Caregiving Assistance for Home-Dwelling, Functionally Impaired Older Adults in the United States, 1998-2012. JAMA 316:218-20
Levine, Deborah A; Burke, James F (2016) Stroke Imaging: Quantity, But is There Quality? Med Care 54:423-5
Yano, Yuichiro; Ning, Hongyan; Muntner, Paul et al. (2015) Nocturnal Blood Pressure in Young Adults and Cognitive Function in Midlife: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Hypertens 28:1240-7
Sauser, Kori; Levine, Deborah A; Hayward, Rodney A (2015) A review of the clinical evidence related to early treatment of elevated LDL for cardiovascular primary prevention. Evid Based Med 20:162-9
Levine, Deborah A; Galecki, Andrzej T; Langa, Kenneth M et al. (2015) Trajectory of Cognitive Decline After Incident Stroke. JAMA 314:41-51
Skolarus, Lesli E; Lisabeth, Lynda D; Burke, James F et al. (2015) Racial and Ethnic Differences in Mental Distress among Stroke Survivors. Ethn Dis 25:138-44
Skolarus, Lesli E; Sanchez, Brisa N; Levine, Deborah A et al. (2014) Association of body mass index and mortality after acute ischemic stroke. Circ Cardiovasc Qual Outcomes 7:64-9
Sauser, Kori; Burke, James F; Reeves, Mathew J et al. (2014) A systematic review and critical appraisal of quality measures for the emergency care of acute ischemic stroke. Ann Emerg Med 64:235-244.e5
Levine, Deborah A; Walter, James M; Karve, Sudeep J et al. (2014) Smoking and mortality in stroke survivors: can we eliminate the paradox? J Stroke Cerebrovasc Dis 23:1282-90
Levine, Deborah A; Langa, Kenneth M; Rogers, Mary A M (2014) Acute infection contributes to racial disparities in stroke mortality. Neurology 82:914-21

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