Can cardiovascular risk management be improved by shared care with general practice to prevent cognitive decline following stroke/TIA? A feasibility randomised controlled trial (SERVED memory).

Autor: Davison WJ; Ageing and Stroke Medicine, Norwich Medical School, University of East Anglia, Bob Champion Research Building, James Watson Road, Norwich, UK., Myint PK; Ageing Clinical & Experimental Research Team (ACER), Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK., Loke YK; Norwich Medical School, University of East Anglia, Norwich, UK., Ravenhill G; Norfolk and Norwich University Hospital, Norwich, UK., Turner D; Norwich Medical School, University of East Anglia, Norwich, UK., Fox C; Norwich Medical School, University of East Anglia, Norwich, UK., Shepstone L; Norwich Medical School, University of East Anglia, Norwich, UK., Potter JF; Ageing and Stroke Medicine, Norwich Medical School, University of East Anglia, Bob Champion Research Building, James Watson Road, Norwich, UK. john.potter@uea.ac.uk.
Jazyk: angličtina
Zdroj: BMC geriatrics [BMC Geriatr] 2020 Sep 17; Vol. 20 (1), pp. 353. Date of Electronic Publication: 2020 Sep 17.
DOI: 10.1186/s12877-020-01760-z
Abstrakt: Background: Cognitive impairment and dementia following cerebrovascular disease are increasingly common in the UK. One potential strategy to prevent post-stroke cognitive decline is multimodal vascular risk factor management. However, its efficacy remains uncertain and its application in vulnerable patients with incident cerebrovascular disease and early cognitive impairment has not been assessed. The primary aim of this study was to assess the feasibility of recruitment and retention of patients with early cognitive impairment post-stroke or transient ischaemic attack (TIA) to a trial of enhanced vascular risk factor management combining primary and secondary care.
Methods: In this single centre, open label trial adults with a recent stroke or TIA and mild cognitive impairment (MCI) were randomised 1:1 to a three-monthly multimodal vascular risk factor intervention jointly delivered by the trial team and General Practitioner (GP), or control (defined as usual care from the GP). Chosen risk factors were blood pressure (BP), total cholesterol, blood glucose (HbA1C) in those with diabetes, and heart rate and adequacy of anticoagulation in those with atrial fibrillation (AF). Similar patients with normal cognition were enrolled in an embedded observational cohort and also received usual care from the GP. Repeat cognitive screening was undertaken in all participants after 12 months.
Results: Seventy three participants were recruited to the randomised trial and 94 to the observational cohort (21.8% of those screened). From the randomised trial 35/73 (47.9%) dropped out before final follow-up. In all groups guideline based rates of risk factor control were mostly poor at baseline and did not significantly improve during follow-up. The observational cohort demonstrated greater decline in cognitive test scores at 12 months, with no difference between the randomised groups.
Conclusions: Recruitment to such a study was feasible, but retention of participants was difficult and generally poor rates of risk factor control suggested insufficient application of the intervention. Consequently, successful scaling up of the trial would require protocol changes with less reliance on primary care services. Any future trial should include participants with normal cognition post-stroke as they may be at greatest risk of cognitive decline.
Trial Registration: ISRCTN, ISRCTN42688361 . Registered 16 April 2015.
Databáze: MEDLINE
Externí odkaz: