METACOHORTS for the study of vascular disease and its contribution to cognitive decline and neurodegeneration: An initiative of the Joint Programme for Neurodegenerative Disease Research

Abstract

Dementia is a global problem and major target for health care providers. Although up to 45% of cases are primarily or partly due to cerebrovascular disease, little is known of these mechanisms or treatments because most dementia research still focuses on pure Alzheimer's disease. An improved understanding of the vascular contributions to neurodegeneration and dementia, particularly by small vessel disease, is hampered by imprecise data, including the incidence and prevalence of symptomatic and clinically “silent” cerebrovascular disease, long-term outcomes (cognitive, stroke, or functional), and risk factors. New large collaborative studies with long follow-up are expensive and time consuming, yet substantial data to advance the field are available. In an initiative funded by the Joint Programme for Neurodegenerative Disease Research, 55 international experts surveyed and assessed available data, starting with European cohorts, to promote data sharing to advance understanding of how vascular disease affects brain structure and function, optimize methods for cerebrovascular disease in neurodegeneration research, and focus future research on gaps in knowledge. Here, we summarize the results and recommendations from this initiative. We identified data from over 90 studies, including over 660,000 participants, many being additional to neurodegeneration data initiatives. The enthusiastic response means that cohorts from North America, Australasia, and the Asia Pacific Region are included, creating a truly global, collaborative, data sharing platform, linked to major national dementia initiatives. Furthermore, the revised World Health Organization International Classification of Diseases version 11 should facilitate recognition of vascular-related brain damage by creating one category for all cerebrovascular disease presentations and thus accelerate identification of targets for dementia prevention.

Vascular Cognitive Impairment in a Memory Clinic Population: Rationale and Design of the “Utrecht-Amsterdam Clinical Features and Prognosis in Vascular Cognitive Impairment” (TRACE-VCI) Study

“…The majority of previous studies on vascular brain injury and cognition are either based on the general population, focusing on patients who experienced a stroke or transient ischemic attack (TIA) [7], or primarily address one particular type of vascular brain injury, such as WMH [42]. It is clearly important to document which clinical phenotypes related to vascular injury can be identified in a memory clinic setting and which factors determine prognosis for the individual patient.…”

“…It thus fills a knowledge gap, as there are few available cohort studies of VCI in this particular setting [7]. As a consequence, despite the fact that vascular brain injury on MRI is a very common finding in memory clinic patients, uncertainty can exist about its clinical and prognostic relevance in individual cases.…”

“…Addressing these uncertainties is important, given the frequent occurrence of vascular lesions in memory clinic patients. Yet, there are few studies on VCI in memory clinic cohorts [7]. …”

The Meta VCI Map consortium for meta‐analyses on strategic lesion locations for vascular cognitive impairment using lesion‐symptom mapping: Design and multicenter pilot study

“…Potential members were identified and invited through other collaborative networks in the VCI research field, including STRIVE [12], METACOHORTS [13], and HARNESS (www.harness‐neuroimaging.org) and asked to fill in a survey to explore their interest in participating and support creation of the data index. As of November 2018, 47 groups have joined Meta VCI Map, and the data index includes approximately 7800 patients with ischemic stroke, 4900 memory clinic patients, and 14,400 population‐based subjects.…”

Full exploitation of high dimensionality in brain imaging: The JPND working group statement and findings

“…Laudable prior efforts from the JPND program—such as STRIVE [5], METACOHORTS [6], and HARNESS—aimed to harmonize, either qualitatively or quantitatively, vascular imaging markers. These initiatives followed decades of research using heterogeneous methods.…”