Effect of small-vessel disease on cognitive trajectory after atrial fibrillation-related ischaemic stroke or TIA

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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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