Biomarkers for Cognitive Decline in Intracerebral Hemorrhage

NCT ID: NCT06836141

Last Updated: 2025-08-08

Basic Information

• Recruitment Status: RECRUITING
• Total Enrollment: 118 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2025-08-02
• Study Completion Date: 2029-08-01

Brief Summary

The goal of this clinical trial is to see if silent brain infarcts (SBIs), or stroke-like symptoms detectable during brain imaging, are a possible contributor to cognitive decline for patients diagnosed with spontaneous intracerebral hemorrhage (sICH), or blood clot in the brain. The main questions it aims to answer are

• if SBIs in sICH are associated with a lower cognitive level and more rapid cognitive decline
• if SBIs in sICH are associated with certain findings on brain imaging
• if SBIs in sICH are associated with higher inflammation measured by certain blood tests

Participants will undergo

• cognitive testing during hospitalization, and at 3, 6 and 12 months after the sICH
• Magnetic Resonance Imaging (MRI) of the brain during hospitalization and 12 months after the sICH
• blood draws during hospitalization and at 3, 6 and 12 months after the sICH

Detailed Description

This proposal's objective is to establish SBIs (silent brain infarct) as an early, pathophysiologically plausible neuroimaging biomarker for VCID (vascular contributions to cognitive impairment and dementia) in sICH (spontaneous intracerebral hemorrhage) patients. To attain the overall objective, we will recruit a cohort of 118 sICH participants over 3 years and longitudinally measure cognitive function, WMH volumetric progression, and serum suPAR levels. Aim #1: To test the hypothesis that SBIs in sICH are associated with a lower cognitive level and more rapid cognitive decline. Approach: In sICH patients with and without SBIs, we will compare global cognition (primary analysis) and multiple cognitive domains (secondary analysis) at hospitalization, and at 3 months, 6 months, and 12 months after discharge using a comprehensive cognitive battery. Aim #2: To test the hypothesis that SBIs in sICH are associated with more rapid WMH (white matter hyperintensities) progression as measured by serial MRI (magnetic resonance imaging). Approach: In sICH patients with and without SBIs, we will compare the absolute volumetric change in WMH using a novel imaging analysis algorithm on serial 3-Tesla brain MRI at hospitalization and at 12 months after discharge. Aim #3: To test the hypothesis that SBIs in sICH are associated with higher chronic systemic inflammation as measured by serum suPAR. Approach: In sICH patients with and without SBIs, we will compare serum levels of suPAR at hospitalization, and at 3 months, 6 months, and 12 months after discharge.

This study will be a prospective longitudinal study of sICH patients comparing those with and without SBIs. All patients with primary sICH are admitted to Rush University Medical Center's (RUMC) Neurosciences Intensive Care Unit and managed by a multi-disciplinary team of neurologists and neurosurgeons according to a standardized protocol based on current guidelines. Primary sICH will be defined as either hypertensive or related to cerebral amyloid angiopathy as diagnosed using the Boston Criteria version 2.0. This differs from secondary sICH, defined as hemorrhage due to vascular malformation, coagulopathy, trauma, malignancy, or reversible vasculopathy. Before hospital discharge, participants will receive baseline cognitive testing, MRI brain, and suPAR (soluble urokinase-type plasminogen activator receptor) serology sampling. After discharge from the hospital, participants will follow up in RUMC's Comprehensive Stroke Clinic at 3 months as part of their routine stroke care per our center's protocol. At the 3-month visit, participants will receive cognitive testing and provide suPAR serology. Participants will complete an interim 6-month visit with cognitive testing and suPAR serology. At a 12-month research clinic visit, participants will repeat cognitive testing, brain MRI, and suPAR serology. All participant encounters will provide the opportunity to gather interim clinical data such as new medical diagnoses or repeat hospitalizations.

Conditions

Primary Intracerebral Hemorrhage

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: PROSPECTIVE

Interventions

MRI

MRI during hospitalization and at 12 months post sICH

Intervention Type: DIAGNOSTIC_TEST

Blood Draw

Will occur during hospitalization and at 3, 6 and 12 months post sICH

Intervention Type: DIAGNOSTIC_TEST

Cognitive Test

Cognitive testing will occur during hospitalization and at 3, 6 and 12 months post sICH

Intervention Type: DIAGNOSTIC_TEST

Eligibility Criteria

Inclusion Criteria

• Primary Intracerebral Hemorrhage
• Age ≥ 18 and < 80 years

Exclusion Criteria

• ICH score > 2
• Pre-existing dementia
• Prior history of stroke
• Neurosurgical evacuation of hematoma

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 80 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

National Institute of Neurological Disorders and Stroke (NINDS)

NIH

Sponsor Role: collaborator

Rush University Medical Center

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Rajeev Garg, MD

Role: PRINCIPAL_INVESTIGATOR

Rush University Medical Center

Locations

Rush University Medical Center

Chicago, Illinois, United States

Site Status: RECRUITING

Countries

United States

Central Contacts

Amanda Sremac, BS

Role: CONTACT

Amanda_C_Sremac@rush.edu

312-942-0593

Rajeev Garg, MD

Role: CONTACT

Rajeev_Garg@rush.edu

Facility Contacts

Rajeev Garg, MD

Role: primary

Rajeev_Garg@rush.edu

Amanda Sremac, BS

Role: backup

Amanda_C_Sremac@rush.edu

312-942-0593

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Other Identifiers

1R01NS135614-01A1

Identifier Type: NIH

Identifier Source: secondary_id

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23022401

Identifier Type: -

Identifier Source: org_study_id