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Transdisciplinary, Translational and Transactional Approach
The 2005 Thomas Willis Lecture. Stroke and Vascular Cognitive Impairment. A
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The 2005 Thomas Willis Lecture
Stroke and Vascular Cognitive Impairment
A Transdisciplinary, Translational and Transactional Approach
Vladimir Hachinski, MD, FRCPC, DSc
Abstract—Advances in stroke are occurring at an unprecedented pace, but often in disciplinary isolation and without
optimal mechanisms for systematically translating, integrating and applying the findings.
Knowledge accrues in pieces, but is understood in patterns. To optimize knowledge acquisition and application,
infrastructures and systems need to be set up along with appealing incentives. The approach needs to be
transdisciplinary, going beyond the bounds of any given discipline, reciprocally translational, and transactional,
meaning that the interchanges have to yield previously agreed benefits to the parties (The Triple T Approach). A new
breed of leaders needs to be developed and nurtured to catalyze the process.
Opportunities abound. Stroke and most brain diseases share the same pathophysiological fundamental mechanisms.
An integrated, systematic approach to these processes could yield not only greater understanding but new, common
therapeutic targets for several diseases. Biphasic clinical trials could combine the best features of pragmatic and
explanatory, randomized clinical trials. The greatest opportunity of all may be the largely under-explored and
under-exploited borderlands between cerebrovascular and Alzheimer disease. One in three of us will have a stroke,
become demented, or both. For each person who has a stroke or Alzheimer disease, two have some cognitive impairment
short of dementia, often subclinical cerebrovascular disease on a substrate of Alzheimer changes. The fact that
cerebrovascular and Alzheimer disease share the same risk factors, provide a great opportunity for prevention, if
implemented at the “brain at risk” stage.
Systematically integrating what we know and evaluating what we do could spur progress. Research is not only an
activity but an attitude. Making evaluation and incentives to excel part of the funding of all stroke activities would yield
far ranging cumulative improvements in all aspects of stroke.
No system can replace the individual initiative, creativity and insights that lead to the great discoveries, but progress
is not made by breakthroughs alone. No one’s work is so exalted that it cannot be improved, nor so humble that it has
no value. We can all make a difference. (Stroke. 2007;38:1396-1403.)
Key Words: Alzheimer disease ? clinical trials ? discovery ? intervention ? stroke
?treatment ? vascular cognitive impairment
partly from the increasing numbers and sophistication of
dedicated researchers. Investigators often push their research
to the limits of their discipline but seldom beyond. This tends
to happen to the detriment of areas that fall between special-
ized interests. Probably subclinical vascular disease is the
most neglected area of all. Our focus has been on clinical,
catastrophic stroke and yet advanced imaging studies suggest
that in 1998 in the United States, 770 000 strokes occurred,
about 9 040 000 so called “silent infarcts” and 1 940 000
nprecedented advances in genetics, proteomics, imag-
ing, informatics, diagnostics and therapeutics stem
microhemorrhages.1These usually inflict subtle cumulative
brain damage resulting in cognitive and behavioral changes
and confer a heightened risk for both clinical ischemic and
hemorrhage stroke. Although the deficits from subclinical
events may be smaller compared with obvious stroke, the
public health burden may be greater, because of the substan-
tially larger number of individuals.
One in three North Americans will experience a stroke, be-
come demented, or both.2For each person over the age of 65
years who has experienced a stroke (8%) or is demented
(8%), two have some cognitive impairment short of dementia
Received December 13, 2006; final revision received January 24, 2007; accepted January 31, 2007.
From the University of Western Ontario, London, Canada.
This article is based in part on the Willis Lecture delivered at the 30th International Stroke Conference in New Orleans, February 2–4, 2005.
Correspondence to Vladimir Hachinski, MD, FRCPC, DSc, Stroke Editorial Office, 100 Collip Circle, Suite 116, London, Ontario, Canada, N6G 4X8.
© 2007 American Heart Association, Inc.
Stroke is available at http://www.strokeaha.orgDOI: 10.1161/01.STR.0000260101.08944.e9
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