About

Robert Stanton is a faculty emeritus at the Department of Mathematics at The Ohio State University. He earned his PhD from Cornell University in 1974. His areas of expertise include harmonic analysis on Lie groups. Stanton has made significant contributions to the field through research on spherical functions on noncompact symmetric spaces, Dirac operators on locally symmetric manifolds, R-torsion and zeta functions for locally symmetric manifolds, Schubert cells and representation theory, and holomorphic extensions of representations, including automorphic functions. His work has been published in prominent mathematical journals such as Acta Mathematica, Inventiones Mathematicae, and the Annals of Mathematics.

Research topics

• Medicine
• Internal medicine
• Cardiology

Selected publications

• Abstract A033: Potential Benefit of Apixaban Among Patients Without High-Risk Hypertension In Cryptogenic Stroke: A Secondary Analysis of the ARCADIA Trial

  Stroke · 2026-01-29

  article

  Background: Multiple trials have found no difference in stroke prevention comparing anticoagulation to antiplatelet therapy in patients with stroke from a potential occult cardioembolic source. One explanation is the failure to exclude patients with index or subsequent strokes due to hypertensive arteriopathy. We sought to determine whether systemic evidence of high-risk hypertension (HRH) modifies the treatment effect of anticoagulation versus antiplatelet therapy after cryptogenic stroke. Methods: This secondary analysis of the Apixaban to Prevent Recurrence After Cryptogenic Stroke in Patients With Atrial Cardiopathy (ARCADIA) trial assessed whether HRH modified the effect of apixaban versus aspirin in patients with cryptogenic stroke and atrial cardiopathy. HRH was defined as systolic blood pressure ≥160 mmHg at enrollment, left ventricular hypertrophy on echocardiography using left ventricular mass index, or both. The primary outcome was recurrent ischemic stroke or systemic embolism. Cox proportional hazards models evaluated treatment effects and interaction with HRH adjusted for 1) CHA 2 DS 2 VASc score and race; 2) individual variables associated with the primary outcome. Unadjusted stratified analyses and cumulative event rate curves were performed. Results: In 945 randomized patients followed over a median of 1.8 years, 351 (37%) had evidence of HRH, and the primary outcome occurred in 67 patients. Among 594 patients without HRH, a lower incidence rate of the primary outcome was observed in patients randomized to apixaban compared to aspirin (21.5 vs 55.1 per 1000 person-years), whereas patients with HRH had higher incidence with apixaban (55.8 vs 31.8 per 1000 person-years). In the crude and fully adjusted models, a significant interaction effect between HRH and antithrombotic treatment arm was observed (p<0.05) (Table 1). Stratified analysis in patients without HRH demonstrated a lower risk for recurrent ischemic stroke or systemic embolism with apixaban (HR 0.40, CI 0.21-0.79, p=0.008). In patients with HRH, there was no evidence for a beneficial effect of apixaban (HR 1.73, CI 0.80-3.72, p=0.164) (Table 2, Figure 1). Conclusion: Evidence of HRH modified the effect of anticoagulation treatment in patients with cryptogenic stroke and atrial cardiopathy. An underappreciated inclusion of strokes due to hypertensive arteriopathy may account for the absent benefit of anticoagulation in prior trials of embolic stroke of unknown source.

  PublisherDOI

• Abstract DP306: Evidence of widening racial disparities in stroke recurrence from 2015 to 2020: A population-based study

  Stroke · 2026-01-29

  article

  Background: Stroke recurrence is associated with significant morbidity and is disproportionately experienced by Black individuals, making it a major target for clinical trials and systems of care. We examined whether stroke recurrence and associated disparities declined from 2015 to 2020 in a large, population-based study of stroke. Methods: Using a well-validated approach, we ascertained all incident TIAs and strokes (including ischemic, intracerebral hemorrhage and subarachnoid hemorrhage) in the Greater Cincinnati Northern Kentucky region during calendar years 2015 and 2020. To increase power, index cases were also ascertained in Black individuals for the last 6 months of 2014 and 2019, respectively. Potential cases were identified by ICD codes, abstracted, and adjudicated by physicians. All stroke events (but no TIAs) during 3 years of follow-up were considered recurrence. Recurrence rates in 2015 and 2020 were first compared with cumulative incidence functions, both overall and race-stratified. The two periods were then compared with a Cox proportional hazard model that was adjusted for age, sex, race, and index stroke subtype. Results: There were 8300 index stroke/TIA events across the two study periods, 3816 in 2015 and 4484 in 2020. Demographic and clinical characteristics were similar between years ( Graphic 1 ), except median age (69 in 2020 vs. 70 in 2015, P=0.01), percentage of Black race (30% in 2020 vs. 27% in 2015, P=0.01), and index event type (70% ischemic infarct in 2020 vs. 66% in 2015, P<0.01). The unadjusted 3-year recurrence rate decreased slightly over time ( Graphic 2 ), 14.4% (95% CI 12.7-16.3%) for 2020 vs. 15.4% (95% CI 13.5-17.6%) for 2015. When comparing 2015 and 2020, the overall recurrence rate was similar in both time periods after adjustment for age, sex, race, and index event type ( Graphic 3 , HR 0.92 95% CI 0.82-1.05); however, there was a marginal interaction between Black race and study year (P=0.09). When this interaction term was included, Black individuals had a stable risk of recurrence in both study periods (HR 1.07, 95% CI 0.87-1.32), while non-Black individuals had a lower risk in 2020 (HR 0.85, 95% CI 0.73-0.995). Conclusions: While recurrence rates were stable overall, there was evidence that the risk of stroke recurrence decreased in non-Black individuals while remaining stable in Black individuals. This suggests widening disparities in recurrent stroke and requires further study.

  PublisherDOI

• Ischemic Stroke Incidence and Severity and Poststroke Cognitive Decline and Incident Dementia

  JAMA Network Open · 2026-04-16

  articleOpen access

  Importance: The association between stroke severity and dementia is well established. However, reports on trajectories of cognitive decline comparing stroke survivors with individuals without stroke in large cohorts are insufficient. Objectives: To examine associations of ischemic stroke incidence and severity with cognitive decline and dementia risk and to explore whether vascular risk factors modify these associations. Design, Setting, and Participants: This cohort study pooled longitudinal data on cognitive function of participants aged 45 years or older and without stroke and dementia at baseline from 3 US prospective cohorts: the Atherosclerosis Risk in Communities study (1987-2019), Framingham Offspring Study (1971-2019), and Reasons for Geographic and Racial Differences in Stroke study (2003-2019). First definite ischemic strokes were reported in each cohort using consistent protocols, with severity defined using the National Institutes of Health Stroke Scale (NIHSS). The data analysis was completed February 27, 2026. Exposure: Incident ischemic stroke categorized as minor (NIHSS 0-5), mild to moderate (NIHSS 6-10), or moderate to severe (NIHSS ≥11). Main Outcomes and Measures: The primary outcomes were decline in global cognition and incident dementia. Secondary outcomes were changes in memory and executive function. Multivariable linear mixed-effects models were used to test the association of stroke incidence and severity with cognitive decline. Results: A total of 42 342 participants from the pooled cohorts were included (mean [SD] age, 61.3 [9.8] years; 55.0% female). Longitudinal cognitive testing data were available for a median of 11.1 years (range, 0-29.7 years) with 397 344 person-years of observation for dementia incidence. Stroke severity data were available for 1055 of 1505 first-ever ischemic stroke survivors (70.1%). Compared with participants with no stroke, adjusted hazard ratios for incident dementia were 1.93 (95% CI, 1.52-2.45) for NIHSS 0 to 5, 3.26 (95% CI, 1.93-5.53) for NIHSS 6 to 10, and 5.06 (95% CI, 2.71-9.45) for NIHSS 11 or higher. Over the follow-up, higher stroke severity was associated with progressively steeper cognitive declines across all domains, with more prevalent dose-response associations for global cognition (ranging from a mean -0.18 [95% CI, -0.19 to -0.18] points per year for no stroke to -0.58 [95% CI, -0.73 to -0.42] points per year for moderate to severe stroke) and memory (ranging from a mean -0.15 [95% CI, -0.16 to -0.14] points per year for no stroke to -0.36 [95% CI, -0.51 to -0.21] points per year for moderate to severe stroke) than for executive function (ranging from a mean -0.33 [95% CI, -0.34 to -0.32] points per year for no stroke to -0.52 [95% CI, -0.66 to -0.39] points per year for moderate to severe stroke). Conclusions and Relevance: This large cohort study of participants from 3 prospective cohorts found that greater stroke severity was associated with substantially elevated dementia risk and accelerated decline in global cognition, memory, and executive function. These findings underscore the critical importance of stroke prevention, particularly severe stroke, and identifying mechanisms that may link stroke to cognitive decline.

  PublisherOA PDFDOI

• Abstract WP116: Symptoms and neurologic deficits at stroke presentation associated with functional dependence and health-related quality of life after minor acute ischemic stroke

  Stroke · 2026-01-29

  article

  Background: Predicting the small proportion of acute ischemic stroke (AIS) patients with minor deficits (NIHSS<6) who may have poor outcomes could help guide AIS reperfusion decisions in this population. Using a population-based study, we aimed to identify presenting symptoms and NIHSS deficits associated with 1) functional dependence or death (mRS 3-6) after minor AIS and 2) worse health-related quality of life in minor AIS patients functionally independent (mRS < 2) after stroke. Methods: We ascertained all hospitalized adult ( > 18 years) AIS patients presenting to an ED in the Greater Cincinnati/Northern Kentucky region in 2020. Cases were identified by ICD codes and were adjudicated by physicians. Clinical data was abstracted by trained research nurses, including presenting symptoms, initial NIHSS, 3-month mRS, and 3-month health-related quality of life (EQ5D-3L). This analysis included only AIS patients with an initial NIHSS<6 and pre-stroke mRS ≤2 who survived their initial hospitalization and were not discharged to hospice. Multivariable logistic models with least absolute shrinkage and selection operator (Lasso) were used to identify presenting symptoms and NIHSS sub-scores associated with functional dependence/death (mRS 3-6) 3 months after stroke. Linear regression with Lasso was used to explore presenting symptoms and NIHSS sub-scores associated with EQ5D-3L index scores (ranging from 0-1 with lower scores indicating worse quality of life) in patients who reached functional independence (mRS < 2) 3 months after stroke. Results: We identified 1170 minor AIS patients with 3-month mRS available (Graphic 1), of which 317 (27%) were functionally dependent/dead 3 months after stroke (Graphic 2). Numbness as a presenting symptom was associated with lower odds of functional dependence/death (Graphic 3). Walking difficulty/falling and NIHSS sub-score of leg weakness were associated with higher odds of functional dependence/death (Graphic 3). Health-related quality of life was relatively good in patients reaching functional independence 3 months after stroke (n=787 with EQ5D data available, median EQ5D index score 0.85, IQR 0.83-1.0) No presenting symptoms or NIHSS sub-scores were associated with EQ5D index values. Conclusion: Our findings could help clinicians in the often-difficult task of determining disabling symptoms and deficits that could potentially cause long-term dependency when considering AIS reperfusion therapies for minor AIS patients.

  PublisherDOI

• Abstract DP153: Rate of Early Post-Stroke Seizures Has Not Changed Over Time: A Population-Based Study

  Stroke · 2026-01-29

  article

  Background: Post-stroke epilepsy (PSE) is a major contributor to the rising epilepsy burden among older individuals. Early post-stroke seizures (EPSS), a risk factor for PSE, may be affected by changing treatment patterns such as reperfusion in ischemic stroke, but it is unknown whether their prevalence is changing. We used a representative population-based study of stroke to examine the prevalence and trends of EPSS from 2005 to 2020. Methods: The Greater Cincinnati Northern Kentucky Stroke Study is an ongoing stroke surveillance study in the Greater Cincinnati region. Hospitalized strokes were ascertained and adjudicated by stroke physicians in calendar years 2005, 2010, 2015 and 2020. Stroke subtypes were categorized as ischemic strokes (IS), ischemic strokes with hemorrhagic transformation (IS-HT) and primary hemorrhagic stroke (HS, including intracerebral and subarachnoid hemorrhages). The presence of seizures was determined by chart review. EPSS were defined as all clinical or electrographic seizures that occurred during the pre-hospital setting or the initial hospitalization. Patients with history of seizures/epilepsy were excluded. Multivariable logistic regression was used to estimate the effect of study year on EPSS rate after adjusting for age, sex, and race; a second model also adjusted for stroke subtype. Results: We identified 10,312 stroke patients without history of epilepsy across all study periods, of whom 2375 (23.0%) were Black and 5552 (53.8%) were female. Demographics and subtypes are shown in Table 1; there was an increase in the percentage of individuals with IS-HT over time (from 4% in 2005 to 8% in 2020, trend P<0.001). Across all study periods, 432 (4.2%) individuals developed EPSS. The rate of EPSS was stable over time in a model adjusted for age, sex and race (overall effect of study year p=0.96, Table 2). In the second model, stroke subtypes were added with similar results (Table 2). Among subtypes, HS patients had the highest risk of EPSS (OR=4.11 compared to IS, 95% CI 3.34, 5.06, P<0.001), followed by IS-HT patients (OR=2.48 compared to IS, 95% CI 1.73, 3.56, P<0.001). Conclusions: In a representative population-based stroke study, the prevalence of EPSS was 4.2%, which has not changed over time. Patients with HS were at highest risk for EPSS, followed by those with IS-HT. The increase in IS-HT over time may be related to a rise in thrombectomy rates and increased MRI detection. More research on the growing burden of PSE is needed.

  PublisherDOI

• Neighborhood factors and incident stroke: reproducibility of associations across two nationwide cohorts

  Health & Place · 2026-01-18

  articleOpen access

  Research linking adverse neighborhood context with disparities in incident stroke may reflect publication bias for chance associations. We compared results from the REasons for Geographic and Racial Differences in Stroke (REGARDS, n = 25,126, aged ≥45 years, 41 % Non-Hispanic Black, 12 % < high school degree, 2003-2022) study to the Health and Retirement Study (HRS, n = 12,969, aged >50 years, 15 % Non-Hispanic Black, 20 % < high school degree, 2004-2022). We estimated Cox models predicting stroke for 44 census tract variables representing demographic, socioeconomic, labor force, and housing conditions, evaluating inter-cohort consistency of main and race-stratified estimates. Follow-up in REGARDS (median = 12.1 years; IQR: 6.5, 14.9) was similar to HRS (median = 12.6; IQR: 7.0, 17.7). Cumulative stroke incidence was lower in REGARDS (6.6 %, adjudicated) than HRS (15.4 %, reported). Census tract-level household income, median rent, and home values were higher in HRS. Thirty-two of the 44 census tract variables evaluated had associations with incident stroke that differed between cohorts by less than log(0.05). For example, the proportion of housing units built 1980-1999 was associated with stroke incidence in both REGARDS (HR per SD = 0.94 [95 % CI: 0.88, 0.99)] and HRS (HR per SD = 0.92 [95 % CI: 0.87, 0.99) after adjustment for individual-level confounders and state of residence. Five predictors had significant (p < 0.05) interactions with race in HRS, but none of these interactions replicated in REGARDS. Strengthening the evidence base linking neighborhood disadvantage with stroke disparities is essential. Systematic exploration of how heterogeneity in sample composition and outcome ascertainment contributes to diverging findings across studies is needed.

  PublisherDOI

• Abstract A010: Temporal Trends in the Incidence and Case Fatality Rates of Stroke in the Young: A Population-Based Study

  Stroke · 2026-01-29

  article

  Introduction: While declining overall, stroke-related mortality is rising in the young. We sought to better characterize this trend by examining stroke incidence, case fatality rates, and risk factors among young individuals in a large population-based study of stroke from 1993 to 2020. Methods: In a stroke surveillance study covering a 5-county region of southern Ohio and northern Kentucky, hospital cases of stroke were ascertained and adjudicated by trained study physicians during six one-year periods (07/1993-06/1994, 1999, 2005, 2010, 2015, and 2020). Young individuals were defined as ages 20 to 54 years old. Incidence rates were generated using United States Census data standardized to the 2010 population, and 95% confidence intervals were calculated assuming a Poisson distribution. Temporal trends were examined using linear regression. With data from the national death index, 30-day case fatality rates were generated. Trends over time were evaluated with logistic regression, and adjusted for age, race, and sex. Results: There were 2,076 first-ever strokes among young individuals across all study periods. Young individuals with stroke were more likely to have documented hypertension, diabetes, atrial fibrillation, illicit drug use, and marijuana use in recent years (P&lt;0.001). They were more likely to undergo MRI as part of the diagnostic evaluation over time (P&lt;0.001). The incidence rate of stroke among young individuals increased over time (33.88 cases/100,000 person-years in 1993/4, to 63.73 cases/100,000 person-years in 2020, trend P=0.03). Over the same time period, the incidence rate in older individuals declined (618.64 cases/100,000 person-years in 1993/4, to 450.61 cases/100,000 person-years in 2020, trend P=0.01). Examining stroke subtypes, the rise in incidence was primarily driven by an increase in ischemic stroke (trend p=0.02), without statistically significant trends in hemorrhagic stroke. There was a modest decline in the 30-day case fatality rate over time only in young individuals (11.7% in 1993/4, to 9.4% in 2020, trend P=0.0014). Discussion: Stroke incidence is rising in young adults, predominantly due to ischemic strokes. Meanwhile, stroke incidence is declining in older adults. The incidence trend in young stroke coincides with an increase in both traditional risk factors and substance use, though more detailed documentation could be a factor. Further research is needed to understand these worrisome trends for stroke in the young.

  PublisherDOI

• Abstract TP241: Large Vessel Occlusion Stroke in A Population: Prevalence, Presenting Characteristics, Treatment, and Mortality

  Stroke · 2025-01-30

  article

  Background: Large vessel occlusion (LVO) is associated with high morbidity and mortality but has had major advances in treatment options. Prior studies in the United States have been limited by referral bias. We sought to study the population-based prevalence, presenting features, management, and mortality of LVO stroke. Methods: From the Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS), we selected patients with a diagnosis of acute ischemic stroke (AIS) using ICD-10 codes in adults ≥18 years of age presenting with symptomatic intracranial LVO stroke confirmed on vessel imaging within study year 2020. LVO stroke was defined as occlusion limited to the intracranial internal carotid artery (ICA), the M1 segment of the middle cerebral artery (MCA), and the basilar artery (BA). Non-LVO stroke included events due to any other cause. All cases were physician reviewed using GCNKSS epidemiologic criteria. Demographic information, medical history, presenting features, use of advanced imaging, and treatment were collected for each patient. Prevalence was calculated with 95% confidence interval (CI) per 100,000 using 2020 census Demographic and Housing Characteristics in the GCNKSS region. Mortality from any cause within 30 days was calculated using the National Death Index. Results: In 2020, 3,033 AIS events were ascertained in the GCNKSS, with a median age of 69 years (IQR 60-80), 24% black, and 52% female. Events with no vessel imaging available were excluded (n=283). Of the remaining 2,750 events, 279 (10.1%) presented with LVO stroke and had similar demographics to the overall cohort. The prevalence of LVO was 24.7 per 100,000 people (95% CI: 21.9, 27.8). In descriptive analysis, LVO stroke events presented earlier and with higher NIHSS than those without. 159 (14.1%) presented with an intracranial ICA, M1, or BA occlusion among all ischemic events within 6 hours of last known normal. Discharge mRS was also higher (TABLE 1). The 30-day mortality for first time stroke was 30.1% (95% CI: 24.6, 36.0) for stroke due to LVO compared to 8.1% (95% CI: 7.0, 9.2) in non-LVO stroke. Conclusion: One in ten ischemic stroke patients harbor an intracranial ICA, M1, or BA occlusion at the population level. They continue to demonstrate worse outcomes despite treatment advances.

  PublisherDOI

• Projecting US Population Eligibility for Minimally Invasive Surgical Evacuation of Intracerebral Hemorrhage

  Stroke · 2025-09-17

  articleOpen access

  BACKGROUND: Minimally invasive surgical evacuation improved outcomes for patients with acute, spontaneous, lobar intracerebral hemorrhage (ICH) in the ENRICH trial (Early Minimally Invasive Removal of ICH). We determined the percentage of patients with ICH in a US population-based study eligible for minimally invasive surgical evacuation and projected the annual number of patients with ICH in the United States in 2020 eligible for this therapy. METHODS: codes, clinical data abstracted, and physician adjudicated. Location and volume of ICH were centrally adjudicated by neuroradiologists. We applied ENRICH trial criteria to calculate conservative and liberal estimates of the percentage of patients with (1) all ICH at any location and (2) lobar ICH eligible for minimally invasive surgical evacuation. We extrapolated our estimates to the 2020 US adult population using 2020 US census data. RESULTS: We identified 196 patients in Greater Cincinnati/Northern Kentucky in 2015 with acute, spontaneous ICH. After applying all criteria, 2.0% (n=5) of all patients with acute ICH (5.1%; n=5 lobar ICH) were eligible for minimally invasive surgical evacuation. The most common exclusion criteria were ICH volume <30 mL (60%) and prestroke modified Rankin Scale score >1 (52%). In liberal estimates, 2.6% to 3.6% (n=4-7) of all patients with acute ICH (4.1%-7.1% of lobar ICH) were eligible. We projected 1066 to 1848 patients of an estimated 72 283 adult patients with ICH in the United States in 2020 met eligibility criteria. CONCLUSIONS: Approximately 2% to 4% of patients with ICH in our population were eligible for minimally invasive surgical evacuation based on ENRICH criteria, which extrapolates to 1066 to 1848 patients with ICH in the United States annually. Future research is needed to determine whether indications for effective surgical therapy for ICH can be expanded.

  PublisherOA PDFDOI

• Differences in In‐Hospital and Post‐Discharge Ischemic Stroke Care According to Prestroke Functional Status

  Journal of the American Heart Association · 2025-05-26

  articleOpen access

  Background Limited data exist regarding differences in ischemic stroke care across the care continuum between patients with and without prestroke disability. We investigated differences in in‐hospital and postdischarge ischemic stroke cause evaluation and treatment between patients with and without prestroke disability using population‐based data in the United States. Methods We ascertained all adult patients (≥18 years) hospitalized with acute ischemic stroke within the Greater Cincinnati/Northern Kentucky population between January 1, 2015, and December 31, 2015. We used univariate analyses and logistic regression to compare differences in acute ischemic stroke reperfusion therapies, stroke cause evaluation, prescription of secondary stroke prevention treatments, and rehabilitation between patients with prestroke disability (modified Rankin Scale score ≥2) and those without prestroke disability (modified Rankin Scale score 0–1). Results Of 2476 ischemic stroke patients, 1326 (53%) had prestroke disability. Prestroke disability was associated with lower odds of receiving thrombolysis (adjusted odds ratio [aOR], 0.43 [95% CI, 0.28–0.68], P &lt;0.01) and endovascular thrombectomy (aOR, 0.32 [95% CI, 0.13–0.78], P &lt;0.01). Patients with prestroke disability were less likely to receive complete in‐hospital stroke cause evaluation (aOR, 0.48 [95% CI, 0.33–0.69], P &lt;0.01) and there were small differences in antiplatelet (84% versus 87%) and statin therapy (80% versus 86%) prescribed at discharge. Those with prestroke disability were more likely to receive in‐hospital (aOR, 2.6 [95% CI, 2.11–3.21], P &lt;0.01) and postdischarge rehabilitative therapies (aOR, 2.27 [95% CI, 1.86–2.77], P &lt;0.01). Conclusion Further research into factors driving medical decision‐making for patients with prestroke disability is needed to optimize the entire spectrum of ischemic stroke care for this population.

  PublisherDOI

Frequent coauthors

• Dawn Kleindorfer

  Michigan Medicine

  144 shared

• Stacie L Demel

  McMaster University

  143 shared

• Daniel Woo

  University of Cincinnati

  141 shared

• Mary Haverbusch

  138 shared

• Brett Kissela

  137 shared

• Kyle B Walsh

  Walsh University

  135 shared

• Eva Mistry

  University of Cincinnati

  135 shared

• Elisheva Coleman

  University of Chicago

  134 shared