Mild Stroke Study 3 (MSS3)

The Mild Stroke Study 3 (MSS3) aims to understand how small blood vessel problems in the brain affect individuals who have experienced minor strokes. Led by Professor Joanna Wardlaw, this longitudinal study investigates the causes and impacts of mild stroke from various perspectives including medical, dietary, sleep, cognitive, mood, and psycho-motor factors.

MSS3 focuses on the symptoms, brain lesion changes, and blood vessel abnormalities associated with sporadic small vessel diseases (SVDs). By analysing these factors, the study seeks to identify new targets for SVD prevention and therapy.

Participants, who have suffered minor strokes due to SVD, undergo brain MRI scans to monitor changes in SVD lesions, assess the integrity of white and grey matter, and evaluate small vessel blood flow and blood-brain barrier leakage. Additionally, retinal small vessels are imaged, blood pressure and systemic vascular compliance are measured, and detailed information on medical history and lifestyle is collected.

With the hope of determining what exacerbates or mitigates SVD, MSS3 examines the relationships between small vessel dysfunction, SVD lesion development, and the clinical, cognitive, and physical features of SVD. By understanding these connections, the study aims to reveal why some individuals are more vulnerable to SVD and explore potential reversibility of the condition. This research is crucial as SVD is a leading cause of strokes and contributes significantly to dementia.

For the last few years the SVD research group has benefited from the enthusiasm and kindness of 230 patients with minor stroke who are taking part in the Mild Stroke Study 3. This study is the third in the trilogy and follows on from the successful MSS1 and MSS2. In the MSS3, patients return for repeated clinical assessment, repeated brain scans (magnetic resonance scans which are able to give us very detailed pictures) and retinal scans and we have been able to build up a picture of what happens to patients up to three years after stroke.

This has led to many useful and hopefully beneficial scientific discoveries including the identification of new symptoms that may be linked to brain small vessel disease. In addition to this we have found out that in some patients the brain scans appearance associated with disease improve and in some they worsen but more importantly what the predictors of improvement are so we can focus on this area in all patients. 

We have used these findings to design new clinical services for patients with cerebral small vessel disease including establishing new international collaborations of clinicians working in this area aiming to improve the clinical care of patients with small vessel disease worldwide.

Dr Fergus Doubal