SMART MR Study
SMART MR Study
The SMART-MR study is a single-center prospective cohort study among non-demented individuals with vascular disease referred to the University Medical Center (UMC) Utrecht, the Netherlands. The SMART-MR cohort forms a unique population of independently living individuals with symptomatic atherosclerotic disease and aims at investigating risk factors and consequences of brain changes on MRI and changes in cognition.
Recruitment and participants
Recruitment of participants and baseline examinations started in 2001. The UCC-SMART cohort – of which the SMART-MR is a sub-study - recruited participants newly referred to the University Medical Center Utrecht with symptomatic or asymptomatic vascular disease. Participants of the SMART cohort with symptomatic vascular disease, i.e. manifest coronary artery disease, cerebrovascular disease, peripheral arterial disease, or an abdominal aortic aneurysm, and without contraindications for brain imaging, were invited to participate in the SMART-MR study. Written informed consent was obtained from all participants. All participants of SMART-MR still alive were invited for follow-up measurements, including MRI of the brain and neuropsychological testing, in January 2006 (wave 2) and November 2013 (wave 3). The most recent, third wave was completed in October 2017. Retention rates of SMART-MR are 58% and 44% for wave 2 and wave 3, respectively, with 87% of the participants at baseline being alive at wave 3.
|Inclusion criteria for SMART-MR||Exclusion criteria for SMART-MR|
Participants from SMART study with at one of the following diseases:
- Manifest coronary artery disease
Minors or incapacitated individuals
MR contraindications (metal objects in body, claustrophobia, pregnancy)
Diagnosis of terminal malignancy
|Willingness to participate in longitudinal follow-up and additional testing||Lack of independence in daily activities (Rankin scale > 3)|
|Willingness and ability to provide written informed consent||Lack of fluency in Dutch|
|Referral back to the referring specialist|
At baseline SMART-MR participants completed questionnaires about risk factors, medical history, lifestyle and functioning before their visit to the clinic. At the clinic they underwent a medical examination, laboratory tests, comprehensive cognitive testing, and 1.5T magnetic resonance imaging (MRI) of the brain.
At the first follow-up (wave 2), after 4 years on average, measurements were repeated and the following were added as part of the SMART-Medea study: presence and history of depression (Composite International Depression Interview), severity of depressive symptoms (Patient-Health-Questionnaire-9), psychosocial vulnerability, psychosocial stressors early and later in life, measurement of salivary cortisol, as well as a T1-weighted three-dimensional (3D) fast field-echo (FFE) sequence for measuring hippocampal volumes.
During the second follow-up (wave 3), questionnaires and brain outcomes were assessed, including 1.5T MRI and neuropsychological examinations. In addition, around 200 participants also underwent 7T brain MRI. Furthermore, starting in 2006, participants completed bi-annual questionnaires of depressive symptoms and subjective cognitive decline during 10 years of follow-up.
The cohort is continuously monitored for vascular events and mortality through yearly questionnaires and additionally evaluated by physicians of the UCC-SMART Study Endpoint Committee. Finally, a linkage with the Central Bureau of Statistics / Centraal Bureau voor de Statistiek, the Dutch Hospital Data foundation and the Netherlands Cancer Registry is obtained.
A detailed description of the (SMART-MR) study design can be found at:
- Geerlings MI, Appelman APA, Vincken KL, Mali WPTM. Association of white matter lesions and lacunar infarcts with executive functioning. Am J Epidemiol. 2009 Nov; 170(9):1147–55.
- Geerlings MI, Appelman APA, Vincken KL, Algra A, Witkamp TD, Mali WPTM, et al. Brain volumes and cerebrovascular lesions on MRI in patients with atherosclerotic disease. The SMART-MR study. Atherosclerosis. 2010 May; 210(1):130–6.
The Netherlands Consortium of Dementia Cohorts (NCDC)
NCDC consists of nine Dutch cohort studies including the SMART-MR study. The main objective of this project is to unravel the pathophysiology of dementia with a specific focus on amyloid and vascular pathologies in order to find clues for primary prevention by performing a pooled analysis of cohorts on aging and dementia.
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Detection of early cognitive impairment through language in Alzheimer’s disease
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Prognosis of ischemic stroke in different imaging phenotypes
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Linkage with Centraal Bureau voor de Statistiek (CBS) / Statistics Netherlands
Data from CBS are linked to SMART-MR participants and are analyzed within the secure CBS environment. Thereby, information on important clinical endpoints can be obtained to enrich the dataset.