SEARCHCOHORTneurology, stroke medicine

cohort·neurology, stroke medicine, rehabilitation medicine, neuropsychology, neuroradiology·PMC10173956

FIND Stroke Recovery Study (FIND): rationale and protocol for a longitudinal observational cohort study of trajectories of recovery and biomarkers poststroke

BMJ Open · 12 authors, 14 centres

AI SUMMARY

FIDELITY 100%

POPULATIONAdults (≥18 years) with first-ever acute ischemic stroke or intracerebral hemorrhage, admitted to Sahlgrenska University Hospital, Gothenburg, Sweden; prestroke mRS <3; no severe neurodegenerative disease, cerebral neoplasm, or terminal illness.

INTERVENTIONNo intervention; observational study with repeated assessments at baseline, 3 months, 6 months, 1 year, 2 years, and 5 years poststroke.

COMPARISONNo comparison group; within-cohort trajectories and biomarker associations.

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TL;DR

The FIND Stroke Recovery Study is a prospective observational cohort that will enroll at least 500 first-ever stroke patients in Sweden and follow them for 5 years with repeated assessments of cognition, neurological function, neuroimaging, and blood biomarkers. The study aims to map domain-specific recovery trajectories and identify clinical, imaging, and molecular predictors of poststroke outcomes. Its findings could improve prognostic information for patients and inform future biomarker-guided rehabilitation trials.

Full summary

4,631 CHARS

**Background:** Stroke is the leading cause of adult disability, yet knowledge of individual-level recovery trajectories and their underlying biological mechanisms remains limited. Most existing studies focus on motor function or global disability scales (e.g., mRS) and do not capture the full complexity of recovery across domains, particularly cognition. Cognitive impairment affects at least 75% of stroke survivors in the early phase, but trajectories vary by domain and over time. The FIND Stroke Recovery Study was designed to address these gaps by combining repeated, multi-domain clinical assessments with broad blood and imaging biomarker profiling.

**Methods:** This is a prospective, longitudinal, observational cohort study recruiting patients with first-ever ischemic stroke or intracerebral hemorrhage from the stroke unit at Sahlgrenska University Hospital, Gothenburg, Sweden. Inclusion began in January 2018, with a target of at least 500 patients (minimum 300 with ≥3 in-person follow-ups). Recruitment is expected to continue until 2026, with follow-up through 2030. By February 2023, 305 patients had been enrolled and 5 had completed the 5-year visit. Inclusion criteria: age ≥18 years, first-ever acute ischemic stroke or intracerebral hemorrhage. Exclusion criteria: prestroke mRS ≥3, severe neurodegenerative disease, cerebral neoplasm, terminal illness. Patients with severe cognitive impairment or aphasia are not excluded. Assessments occur at baseline (during hospital stay) and at 3 months, 6 months, 1 year, 2 years, and 5 years poststroke. Baseline measures include NIHSS (total and subscales), prestroke mRS, SIS subscales (strength, memory/thinking, communication, mobility, participation), MoCA (total and subtasks for attention/working memory, executive function, visuospatial construction, episodic memory, language), FMA-UE, SAFE, FAC, 10 m walk test, and BBS. Follow-up adds TMT A, B, and D, RSCT (versions A and B), and for participants <55 years: CWT parts 1–3 (D-KEFS), 10-word test (RBANS), and FAS. Patients with aphasia complete the 15-item BNT and language comprehension items from ACE-R and NGTA. PROMs include SIS subscales, D-FIS, life satisfaction (Lisat11), and HADS. Neuroimaging includes CT at baseline and study-specific MRI at baseline, 3–6 months, 1 year, and 2 years. Blood samples (EDTA plasma, citrate plasma, serum, whole blood for RNA) are collected at all time points after overnight fast, processed within 2 hours, and stored at −80°C (whole blood RNA at −20°C). Planned analyses include multiomics profiling (metabolites, proteins, RNA, DNA). Clinical variables (rehabilitation, treatments, vascular risk factors, physical activity, socioeconomic status, infections including COVID-19, comorbidities) are updated at each visit. Recurrent stroke and major vascular events are identified continuously via national registers (Swedish Population Register, National Patient Register, Prescribed Drugs Register, Cause of Death Register, Riksstroke). Ischemic stroke subtyping uses TOAST, CCS, and OSCP; ICH uses SMASH-U.

**Key Results:** This is a protocol paper; no results are reported. The study is ongoing. Key design features include: (1) repeated, domain-specific cognitive testing beyond global measures; (2) blood biomarker sampling at every visit; (3) advanced MRI at multiple time points; (4) inclusion of patients with aphasia and severe cognitive deficits; (5) patient and public involvement in protocol design (a survey identified prognostic information and cognitive deficits as top priorities, leading to protocol refinement to reduce respondent burden); (6) remote follow-up options (telephone MoCA) during COVID-19; (7) register-based follow-up for patients unable to attend visits, minimizing attrition bias.

**Clinical Implications:** The FIND study will generate novel, time-resolved data on the natural history of recovery across multiple domains (cognition, motor function, neurological deficits, patient-reported outcomes) in a well-characterized, all-ages stroke cohort. By linking these trajectories to blood and imaging biomarkers, the study may identify molecular pathways active at different recovery stages and optimal time windows for biomarker measurement. This could enable more individualized prognosis for patients and families, and inform the design of future trials of adjuvant recovery-enhancing therapies. The study's comprehensive phenotyping and repeated biomarker sampling distinguish it from other ongoing cohorts (OX-CHRONIC, STROKE-Cog, DISCOVERY, ODYSSEY, R4VaD, APPLE) and will facilitate external validation across studies.

PICO

PPOPULATION

Adults (≥18 years) with first-ever acute ischemic stroke or intracerebral hemorrhage, admitted to Sahlgrenska University Hospital, Gothenburg, Sweden; prestroke mRS <3; no severe neurodegenerative disease, cerebral neoplasm, or terminal illness.

IINTERVENTION

No intervention; observational study with repeated assessments at baseline, 3 months, 6 months, 1 year, 2 years, and 5 years poststroke.

OOUTCOME

Trajectories of global and domain-specific cognitive function (MoCA, TMT, RSCT, CWT, RBANS, BNT, FAS), neurological function (NIHSS, mRS), motor function (FMA-UE, SAFE, FAC, 10 m walk, BBS), patient-reported outcomes (SIS, D-FIS, HADS, life satisfaction), and associations with blood biomarkers (protein, RNA, DNA) and neuroimaging biomarkers.

STUDY TYPE

cohort

SPECIALTY

neurology

SUMMARISED BY

AI pipeline

FIDELITY CHECK

100% · A

ORIGINAL PAPER

PMC10173956

FIND Stroke Recovery Study (FIND): rationale and protocol for a longitudinal observational cohort study of trajectories of recovery and biomarkers poststroke

BMJ Open

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ABSTRACT

Introduction Comprehensive studies mapping domain-specific trajectories of recovery after stroke and biomarkers reflecting these processes are scarce. We, therefore, initiated an exploratory prospective observational study of stroke cases with repeated evaluation, the FIND Stroke Recovery Study . We aim to capture trajectories of recovery from different impairments, including cognition, in combination with broad profiling of blood and imaging biomarkers of the recovery. Methods and analysis We recruit individuals with first-ever stroke at the stroke unit at the Sahlgrenska University Hospital, Sweden, to FIND. The inclusion started early 2018 and we aim to enrol minimum 500 patients. Neurological and cognitive impairments across multiple domains are assessed using validated clinical assessment methods, advanced neuroimaging is performed and blood samples for biomarker measuring (protein, RNA and DNA) at inclusion and follow-up visits at 3 months, 6 months, 1 year, 2 years and 5 years poststroke. At baseline and at each follow-up visit, we also register clinical variables known to influence outcomes such as prestroke functioning, stroke severity, acute interventions, rehabilitation, other treatments, socioeconomic status, infections (including COVID-19) and other comorbidities. Recurrent stroke and other major vascular events are identified continuously in national registers. Ethics and dissemination FIND composes a unique stroke cohort with detailed phenotyping, repetitive assessments of outcomes across multiple neurological and cognitive domains and patient-reported outcomes as well as blood and imaging biomarker profiling. Ethical approval for the FIND study has been obtained from the Regional Ethics Review Board in Gothenburg and the Swedish Ethics Review Board. The results of this exploratory study will provide novel data on the time course of recovery and biomarkers after stroke. The description of this protocol will inform the stroke research community of our ongoing study and facilitate comparisons with other data sets. Trial registration number The protocol is registered at http://www.clinicaltrials.gov , Study ID: NCT05708807 .

CITATION EXPORT

Cecilia Brännmark, Sofia Klasson, Tara M Stanne et al.. FIND Stroke Recovery Study (FIND): rationale and protocol for a longitudinal observational cohort study of trajectories of recovery and biomarkers poststroke. BMJ Open. (2023). https://doi.org/10.1136/bmjopen-2023-072493

AUTHORS

12 · 14 CENTRES

Cecilia Brännmark, Sofia Klasson, Tara M Stanne, Hans Samuelsson, Margit Alt Murphy, Katharina S Sunnerhagen, N. David Åberg, Oscar Jalnefjord, Isabella Björkman-Burtscher, Katarina Jood, Turgut Tatlisumak, Christina Jern

1Department of Laboratory Medicine, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
2Region Västra Götaland, Sahlgrenska University Hospital, Department of Research, Development, Education and Innovation, Gothenburg, Sweden
3Region Västra Götaland, Sahlgrenska University Hospital, Department of Clinical Genetics and Genomics, Gothenburg, Sweden
4Institute of Psychology, Faculty of Social Sciences, University of Gothenburg, Gothenburg, Sweden
5Region Västra Göraland, Sahlgrenska University Hospital, Department of Rehabilitation Medicin, Gothenburg, Sweden
6Region Västra Götaland, Sahlgrenska University Hospital, Department of Occupational Therapy and Physiotherapy, Gothenburg, Sweden
7Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
8Region Västra Götaland, Sahlgrenska University Hospital, Department of Acute Medicine and Geriatrics, Gothenburg, Sweden
9Institute of Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
10Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden
11Region Västra Götaland, Sahlgrenska University Hospital, Department of Medical Physics and Biomedical Engineering, Gothenburg, Sweden
12Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden
13Region Västra Götaland, Sahlgrenska University Hospital, Department of Radiology, Gothenburg, Sweden
14Region Västra Götaland, Sahlgrenska University Hospital, Department of Neurology, Gothenburg, Sweden