It is a common clinical occurrence that neuroimaging scans obtained in the course of routine care discover covert cerebrovascular disease (CCD). Some patients may have what appears to be an old stroke on the scan, though they never had a clinically evident stroke, and other patients may have a pattern of damage known as "white matter disease" (WMD). Both of these findings are believed to be due to small vessel disease in the brain. These patients are at very high risk of future stroke and dementia, but there are no proven preventive treatments or guidelines for initiating risk factor-modifying therapy, in part because the patients are difficult to identify. In previous NIH-supported work, the Predictive Analytics and Comparative Effectiveness (PACE) Center at Tufts Medical Center's Institute for Clinical Research and Health Policy Studies, led by Dr. David Kent, working with Mayo Clinic, has develop a natural language processing (NLP) algorithm that identifies these patients at scale and can characterize the extent of the covert cerebrovascular disease. They used this algorithm to study a large cohort of patients and to perform the first large scale study of patients with incidentally-discovered covert cerebrovascular disease. They found that patients with incidentally discovered covert cerebrovascular disease have about a two- or three-fold risk in the occurrence of future stroke or dementia, among other findings. This team was just awarded a new grant co-funded by the National Institute of Neurological Disorders and Stroke (NINDS) and National Institute on Aging (NIA) for a five year $4.7M project to: (1) expand the cohort; (2) perform additional epidemiological studies on these patients; and (3) develop a platform for a clinical trial in this population to prevent future stroke and dementia.
This project will be led by Dr. David Kent, Director of the PACE Center in ICRHPS at Tufts Medical Center; Professor of Medicine, Neurology, and Clinical and Translational Science; and Director of the Clinical and Translational Science Program at Tufts University School of Medicine. He will be joined by PACE Center investigator Dr. Lester Leung, Director of the Comprehensive Stroke Center at Tufts Medical Center and Associate Professor at Tufts University School of Medicine; Ellen Vickery, clinical studies manager at Tufts Medical Center; Dr. Wansu Chen, Research Scientist at Kaiser Permanente Southern California; Dr. Mai Nguyen-Huynh, Chief of Neurology and Research Scientist at Kaiser Permanente Northern California; Dr. James Burke, Professor of Neurology at Ohio State University; Dr. Eric Smith, Professor of Neurology and Medical Director of the Cognitive Neurosciences Clinic at University of Calgary; and Dr. William Whiteley, Reader in Neurology in the Centre for Clinical Brain Sciences at the University of Edinburgh and Senior Clinical Fellow in the MRC Population Health Research Unit at the University of Oxford.