title: The Cognition and Affect after Stroke - a Prospective Evaluation of Risks (CASPER) study: rationale and design.
abstract: BACKGROUND
  Cognitive impairment and neuropsychiatric syndromes, like depression and apathy, are frequent residual consequences of stroke. These have a large impact on quality of life and long-term prognosis. Several factors are involved in the development of these residual syndromes, although their exact role and their interrelationships remain still rather unclear. The Cognition and Affect after Stroke: a Prospective Evaluation of Risks (CASPER) study has been primarily designed to examine whether stroke-specific (e.g. lesion location, volume, type, severity), cerebrovascular and neurodegenerative (e.g. white matter changes, atrophy, microbleeds, perivascular spaces), inflammatory, endothelial, and (epi)genetic markers are associated with cognitive impairment, post-stroke depression, and post-stroke apathy, and whether they predict their course over 12 months. The secondary aims are to investigate how the above-mentioned markers interact with each other, and to determine if patients with apathy and depression after stroke differ in pathogenesis, course, and outcome (e.g. functional outcome, neurocognitive performance, quality of life).
  
  
  METHODS
  CASPER is a 1-year prospective clinical cohort follow-up study in 250 stroke patients recruited at the neurological in- and outpatient services at Maastricht University Medical Center (MUMC+, Maastricht, The Netherlands), and Zuyderland Medical Center (Sittard and Heerlen, The Netherlands). At baseline (3 months post-stroke), a neuropsychological assessment, neuropsychiatric interview, blood sample, and brain magnetic resonance imaging (MRI) scan are conducted. Assessment of neuropsychiatric and neurocognitive status are repeated 6 and 12 months later.
  
  
  CONCLUSIONS
  The CASPER study investigates stroke-specific, vascular, neurodegenerative, inflammatory, and genetic markers of the development of vascular cognitive impairment, depression, and apathy after stroke. This creates the possibility to study not only the contribution of these individual markers but also their joint contribution, which differentiates this study from earlier stroke cohorts who lacked long-term follow-up data, a large sample size, an extensive MRI protocol, and markers from the blood. The knowledge we derive from this study might help in identifying markers that are associated with, or can predict the onset, maintenance, and progression of vascular cognitive impairment, depression, and apathy after stroke, and could provide new insights into possibilities for treatment and rehabilitation that result in better functional outcome after stroke.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT02585349.
authors.affiliation: Alzheimer Center Limburg and School for Mental Health and Neuroscience (MHeNS), Department of Psychiatry and Neuropsychology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands. elles.douven@maastrichtuniversity.nl.
authors.forename: Elles
authors.initials: E
authors.lastname: Douven
authors.affiliation: Alzheimer Center Limburg and School for Mental Health and Neuroscience (MHeNS), Department of Psychiatry and Neuropsychology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.
authors.forename: Syenna H J
authors.initials: SH
authors.lastname: Schievink
authors.affiliation: Alzheimer Center Limburg and School for Mental Health and Neuroscience (MHeNS), Department of Psychiatry and Neuropsychology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.
authors.forename: Frans R J
authors.initials: FR
authors.lastname: Verhey
authors.affiliation: Cardiovascular Research Institute Maastricht (CARIM), Department of Neurology, and School for Mental Health and Neuroscience, Maastricht University Medical Center (MUMC+), P.O. BOX 616 (DRT12), 6200 MD, Maastricht, The Netherlands.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: van Oostenbrugge
authors.affiliation: Alzheimer Center Limburg and School for Mental Health and Neuroscience (MHeNS), Department of Psychiatry and Neuropsychology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.
authors.forename: Pauline
authors.initials: P
authors.lastname: Aalten
authors.affiliation: Cardiovascular Research Institute Maastricht (CARIM), Department of Neurology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.
authors.forename: Julie
authors.initials: J
authors.lastname: Staals
authors.affiliation: Alzheimer Center Limburg and School for Mental Health and Neuroscience (MHeNS), Department of Psychiatry and Neuropsychology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Köhler
mesh_terms: D057565:Apathy; D001284:Atrophy / Q000000981:diagnostic imaging / Q000473:pathology / Q000523:psychology; D001921:Brain / Q000000981:diagnostic imaging* / Q000473:pathology; D003071:Cognition; D003072:Cognition Disorders / Q000000981:diagnostic imaging / Q000523:psychology*; D015331:Cohort Studies; D015140:Dementia, Vascular / Q000000981:diagnostic imaging / Q000473:pathology / Q000523:psychology*; D003863:Depression / Q000523:psychology*; D038524:Diffusion Magnetic Resonance Imaging; D005500:Follow-Up Studies; D006801:Humans; D056784:Leukoencephalopathies / Q000000981:diagnostic imaging / Q000473:pathology / Q000523:psychology; D008279:Magnetic Resonance Imaging; D009426:Netherlands; D009483:Neuropsychological Tests; D011446:Prospective Studies; D011788:Quality of Life; D018570:Risk Assessment; D018401:Sample Size; D020521:Stroke / Q000000981:diagnostic imaging / Q000523:psychology*
keywords: Apathy; Cognition; Dementia; Depression; Design; Neuroimaging; Stroke