Grant: Project Grant

When a clot stops blood flow to the brain it causes injury, called a stroke. Strokes cause problems with key functions like movement or cognition (memory and thinking skills). Three-quarters of people can have cognition problems after stroke, and this is among the most feared complications of stroke. Even before 2020, but especially in the COVID-19 pandemic, we need new ways to measure thinking that are easier for people to do. We also need to understand what the cognitive test scores really mean - how to they relate to people's quality of life, or to costs to care for people? We are doing a large study comparing two emergency stroke treatments (Alteplase compared to Tenecteplase, AcT). Using this platform, we propose a new study (AcT-Cog), in which people will complete 6 proven cognitive tasks (www.cambridgebrainsciences.com) on computer at home. The tests will be done 3-6 months after their stroke. This type of study, with easy-to-use tests that people can do at home, has not been tried before as an outcome in studies of new stroke treatments. The first goal of our study will be to see how useable it is (i.e. can people access and complete the tasks?) and understand what makes it easier or harder for people to complete the tasks. The second goal will be to see if cognitive test scores relate to important outcomes like quality of life or future need for health care. The third goal of our study will be to see if the scores from this assessment are different between the groups who get alteplase or tenecteplase. The results of this trial will help us understand when and how computer testing can be used to measure cognition after stroke and will help us understand the importance of changes in the scores. If scores differ between treatment groups, that will help inform treatment for stroke patients around the world and could help to improve cognitive outcomes after stroke.