Banerjee, Gargi, Chan, Edgar, Ambler, Gareth, Wilson, Duncan, Cipolotti, Lisa, Shakeshaft, Clare, Cohen, Hannah, Yousry, Tarek, Lip, Gregory YH 
ORCID: 0000-0002-7566-1626, Muir, Keith W et al (show 80 more authors)
(2019)
Effect of small-vessel disease on cognitive trajectory after atrial fibrillation-related ischaemic stroke or TIA.
, Germany.
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Abstract
Post-stroke dementia is common but has heterogenous mechanisms that are not fully understood, particularly in patients with atrial fibrillation (AF)-related ischaemic stroke or TIA. We investigated the relationship between MRI small-vessel disease markers (including a composite cerebral amyloid angiopathy, CAA, score) and cognitive trajectory over 12 months. We included patients from the CROMIS-2 AF study without pre-existing cognitive impairment and with Montreal Cognitive Assessment (MoCA) data. Cognitive impairment was defined as MoCA < 26. We defined "reverters" as patients with an "acute" MoCA (immediately after the index event) score < 26, who then improved by ≥ 2 points at 12 months. In our cohort (n = 114), 12-month MoCA improved overall relative to acute performance (mean difference 1.69 points, 95% CI 1.03-2.36, p < 0.00001). 12-month cognitive impairment was associated with increasing CAA score (per-point increase, adjusted OR 4.09, 95% CI 1.36-12.33, p = 0.012). Of those with abnormal acute MoCA score (n = 66), 59.1% (n = 39) were "reverters". Non-reversion was associated with centrum semi-ovale perivascular spaces (per-grade increase, unadjusted OR 1.83, 95% CI 1.06-3.15, p = 0.03), cerebral microbleeds (unadjusted OR 10.86, 95% CI 1.22-96.34, p = 0.03), and (negatively) with multiple ischaemic lesions at baseline (unadjusted OR 0.11, 95% CI 0.02-0.90, p = 0.04), as well as composite small-vessel disease (per-point increase, unadjusted OR 2.91, 95% CI 1.23-6.88, p = 0.015) and CAA (per-point increase, unadjusted OR 6.71, 95% CI 2.10-21.50, p = 0.001) scores. In AF-related acute ischaemic stroke or TIA, cerebral small-vessel disease is associated both with cognitive performance at 12 months and failure to improve over this period.
| Item Type: | Conference or Workshop Item (Unspecified) |
|---|---|
| Uncontrolled Keywords: | Atrial fibrillation, Brain ischaemia, Cerebral small-vessel disease, Cognitive impairment, Ischaemic stroke, Transient ischaemic attack (TIA) |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 14 May 2019 09:25 |
| Last Modified: | 19 Jan 2023 00:46 |
| DOI: | 10.1007/s00415-019-09256-6 |
| Open Access URL: | https://doi.org/10.1007/s00415-019-09256-6 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3041216 |
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