World Stroke Day 2023

World Stroke Day Sunday 29 October

This Sunday, October 29th, is World Stroke Day, an annual global awareness campaign aimed at raising awareness about stroke, its risk factors, prevention, and treatment. World Stroke Day is an opportunity for organisations, healthcare professionals, and communities worldwide to come together and promote education and advocacy related to stroke.

The primary objective of the Row Fogo Centre for Research into Ageing and the Brain is to enhance comprehension, diagnosis, and therapy for Small Vessel Diseases (SVD), a significant contributor to stroke, cognitive deterioration, dementia, and mobility issues.

Small Vessel Diseases (SVD) and Stroke

SVD is a medical condition that primarily affects the small blood vessels in the brain. These tiny blood vessels, also known as arterioles, capillaries and venules, play a crucial role in regulating blood flow to different parts of the brain. When these vessels become damaged or diseased, it can lead to various neurological problems. SVD is often associated with conditions such as hypertension (high blood pressure) and ageing.

Approximately 35,000 people in the UK experience a specific type of stroke known as "lacunar" or "small vessel" stroke each year. This type of stroke differs from more common strokes and currently lacks a proven treatment. Small vessel strokes are believed to occur due to damage to the lining of the tiny blood vessels deep within the brain, which disrupts their normal function. This not only leads to strokes but, more significantly, contributes to cognitive and mobility issues, potentially accounting for up to 45% of all dementia cases, either independently or in combination with Alzheimer's disease (affecting around 350,000 patients in the UK).

While SVDs have been identified as a leading factor in age-related brain disorders like stroke, dementia, and Alzheimer's disease, knowledge of this prevalent condition remains quite limited.

Mild Stroke Study 3 (MSS3)

One current research project at the Row Fogo Centre is the Mild Stroke Study 3 (MSS3), a study of the symptoms, brain lesion changes, and blood vessel abnormalities that cause sporadic SVDs.

Under the guidance of Professor Joanna Wardlaw, the MSS3 team investigates various factors influencing small vessel dysfunction in the brain within the context of SVD. Their research aims to understand the impact of this dysfunction on the brain, determine whether the resulting effects are permanent or reversible, identify related contributing factors, and assess the varying susceptibility of individuals to the effects of small vessel dysfunction. This susceptibility may be influenced by factors such as the resilience of the white matter structure.

The MSS3 team enrolled individuals who had previously experienced a minor stroke linked to SVD (lacunar ischaemic stroke) or who had presented with minor non-lacunar ischaemic stroke. They employed brain MRI scans to evaluate the potential changes in SVD lesions over time, the integrity of both white and grey matter, the function and blood flow in small brain vessels, as well as the presence of blood-brain barrier leakage. 

Additionally, they conducted imaging of the retinal small vessels, recorded blood pressure and systemic vascular compliance, and gathered comprehensive information regarding participants' medical history and lifestyle factors. In doing so, the MSS3 team hopes to better understand the connections between small vessel dysfunction, the development of SVD lesions, and the clinical, cognitive, and physical manifestations of SVD.

To learn more about MSS3, click here.

LACI Trials:

Another set of trials worth highlighting on World Stroke Day is the the Lacunar Intervention Trials (LACI-1, LACI-2) randomised controlled trials testing two repurposed drugs, cilostazol and isosorbide mononitrate (ISMN), to prevent worsening of SVD.

There are medications commonly used for other vascular conditions that may hold the potential to enhance small vessel function and prevent further brain damage. One such medication, cilostazol, has undergone testing in stroke patients in the Asia Pacific region but hasn't been explored for dementia. Another drug, isosorbide mononitrate, is widely prescribed in the UK for heart disease but not for stroke.

LACI-1: LACI-1 tested whether a much larger scale study testing the effects of Cilostazol and ISMN on preventing brain damage from small vessel disease would be feasible. The team found that Cilostazol and ISMN are well tolerated when the dose is escalated, without safety concerns, in patients with lacunar stroke. These findings led the way for LACI-2, a larger trial with a longer follow-up period.

LACI-2: Following LACI-1, which established the safety of Cilostazol and ISMN in people with lacunar stroke, the researchers wanted to test whether the study methods were practical so that patients and trial centres could follow the procedures. The LACI-2 team also needed to establish the number of patients displaying stroke-like symptoms or witnessing a decline in their cognitive abilities. 

The results indicate that the LACI-2 trial was practical, and ISMN and cilostazol were well-tolerated and safe. These medications have the potential to decrease the risk of recurrent stroke, dependence, and cognitive decline following a lacunar stroke, and they may also mitigate other adverse effects in SVD.

This information is key to staging a much larger clinical trial to find out if these drugs can prevent worsening of small vessel disease (LACI-3).

To learn more about the LACI trials, click here.

"Thanks to the Row Fogo Centre’s work to ‘see into the brain’ with MR imaging, we understand much more about what goes wrong in small vessel disease. LACI-2 shows that it may be possible to slow or reverse that process. It has sparked great interest around the world in seeing if similar treatments could work for small vessel disease more widely." -  Professor Joanna Wardlaw, Chair of Applied Neuroimaging; Head of Neuroimaging Sciences and Edinburgh Imaging; Row Fogo Centre Director.

Conclusion: 

On this World Stroke Day, we recognize the crucial role of raising awareness and promoting research related to stroke, its risk factors, prevention, and treatment. The Row Fogo Centre for Research into Ageing and the Brain is at the forefront of this mission, particularly focusing on Small Vessel Diseases (SVD), a significant contributor to stroke, cognitive decline, dementia, and mobility issues.