ACCESS@ICL
Research type
Research Study
Full title
An All-inclusive Cohort for the Comprehensive Examination of Sporadic Small Vessel Disease at Imperial College London (ACCESS@ICL)
IRAS ID
342919
Contact name
Alastair Webb
Contact email
Sponsor organisation
Imperial College London
Duration of Study in the UK
10 years, 0 months, 1 days
Research summary
Cerebral small vessel disease (cSVD) is the most prevalent cause of vascular dementia, haemorrhagic stroke and a third of ischaemic strokes, as well as a key contributor to disability and cognitive decline in Alzheimer’s Disease. However, it has highly heterogeneous clinical, imaging and pathophysiological manifestations but most cohorts recruit by single clinical presentations and don’t test vascular physiological dysfunction, biasing our understanding of the disease and limiting understanding of the underlying mechanisms.
The ACCESS@ICL prospective cohort will include patients with any of the core imaging manifestations of cSVD, regardless of clinical presentation (stroke, cognition, mobility, incidental). The whole cohort will have remote demographic, clinical and cognitive assessments with follow up at 1 and 5 years and by healthcare record linkage. A core cohort (100-200 patients per annum, moderate-severe disease, age <75 years) will have detailed face-to-face clinical, functional and cognitive assessments with cardiovascular physiological testing (arterial stiffness, autonomics, cerebral pulsatility, reactivity and autoregulation) and blood samples for measurement of targeted biomarkers (cSVD markers; endothelial function; Aβ40/42; tau-p217) and proteomics. Extended testing in specific subgroups will optimise methods for cognitive and functional assessments, whilst a second substudy will compare physiological MRI methods in 60 participants (neurovascular coupling, reactivity, spontaneous oscillations). The core cohort will have face-to-face clinical, functional and cognitive follow-up at 1 and 5 years. Relationships between factors will be modelled by general linear modelling, cox-proportional hazards and structural equation modelling.
ACCESS@ICL will uniquely include patients with all manifestations of cSVD with detailed physiological and biochemical phenotyping. This is cohort will therefore allow us to define the underlying mechanisms, identify treatment targets and develop methods to better measure disease severity and treatment response.
REC name
East of England - Essex Research Ethics Committee
REC reference
24/EE/0188
Date of REC Opinion
4 Dec 2024
REC opinion
Further Information Favourable Opinion