Wide Spectrum Investigation of Stroke Outcome Disparities on Multiple Levels (WISSDOM)

Stroke is a common cause of disability, but not all subjects who survive a stroke are left
with debilitating sequelae. The human brain is able to self-repair and adapt after injury
through neuroplasticity, which is crucial for stroke recovery. At present, recovery cannot be
completely predicted from clinical stroke variables. A promising theory suggests that the
health status of the stroke host is as important as stroke severity for recovery. Within the
neurological system, health is reflected by the integrity of the brain tissue and its
neuronal environment, which provide the neuroplastic potential that is necessary for
recovery. The potential for neuroplasticity is likely variable across individuals and
possibly accounts for some of the differences in outcome that cannot be explained by other
clinical factors.

A better understanding of the relationship between stroke outcomes, host brain tissue
integrity and recovery environment would have immense potential to address stroke related
disabilities. The investigators are experts in research involving brain tissue integrity
using neuroimaging and recovery environment using community based participation approaches
involving nurse-guided community health workers (CHWs).

This research project will evaluate the relationship between cardiovascular risk factors,
degrees of physical and mental activity prior to the stroke, brain tissue integrity,
post-stroke community participation and neurological recovery after the stroke. The
investigators will recruit and study a biracial cohort, gaining insight into the possible
mechanisms that explain why the adverse risk profile, which is more commonly present in
African-Americans than non-Hispanic Whites in the stroke belt, is translated into a less
favorable recovery post stroke. If a better understanding of the underlying reasons for this
observation can be defined, an important first step toward eliminating this disparity can be
achieved.

Inclusion Criteria:

- 40-75 years

- prestroke mRS score >2

- African American or White

- Reside in Berkeley, Charleston, Dorchester, Colleton or Georgetown Counties

- Ischemic stroke involving only one hemisphere

- Fugl Meyer score >16 at baseline or Aphasia Quotient in Western Aphasia Battery <93

- no contraindications to research MRI

Exclusion Criteria:

- Primary or secondary intracerebral hematoma, or subarachnoid hemorrhage, or subdural/
epidural hematoma; Prisoner; diagnoses of substance addiction (alcohol or illicit
drugs)

- Bihemispheric acute ischemic strokes;

- Other concomitant neurological disorders, such as brain tumor, abscess or spinal cord
disease affecting language or limb motor function;

- Documented history of dementia prior to index event;

- Patient suffered one or more recurrent stroke during the 12-month follow up period.

- Terminal illness with life expectancy ≤ 1 year

- Currently pregnant

- Brain stem strokes