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

Banerjee, Gargi and Chan, Edgar and Ambler, Gareth and Wilson, Duncan and Cipolotti, Lisa and Shakeshaft, Clare and Cohen, Hannah and Yousry, Tarek and Lip, Gregory Y.H. and Muir, Keith W. and Brown, Martin M. and Jäger, Hans Rolf and Werring, David J. and Al-Shahi Salman, Rustam and Shaw, Louise and Harkness, Kirsty and Sword, Jane and Mohd Nor, Azlisham and Sharma, Pankaj and Kelly, Deborah and Harrington, Frances and Randall, Marc and Smith, Matthew and Mahawish, Karim and Elmarim, Abduelbaset and Esisi, Bernard and Cullen, Claire and Nallasivam, Arumug and Price, Christopher and Barry, Adrian and Roffe, Christine and Coyle, John and Hassan, Ahamad and Lovelock, Caroline and Birns, Jonathan and Cohen, David and Sekaran, L. and Parry-Jones, Adrian and Parry, Anthea and Hargroves, David and Proschel, Harald and Datta, Prabel and Darawil, Khaled and Manoj, Aravindakshan and Burn, Mathew and Patterson, Chris and Giallombardo, Elio and Smyth, Nigel and Mansoor, Syed and Emsley, Hedley (2019) Effect of small-vessel disease on cognitive trajectory after atrial fibrillation-related ischaemic stroke or TIA. Journal of Neurology, 266 (5). pp. 1250-1259. ISSN 0340-5354

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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:
Journal Article
Journal or Publication Title:
Journal of Neurology
Uncontrolled Keywords:
/dk/atira/pure/subjectarea/asjc/2700/2728
Subjects:
ID Code:
134638
Deposited By:
Deposited On:
22 Jun 2019 09:16
Refereed?:
Yes
Published?:
Published
Last Modified:
26 May 2020 07:57