Cognitive Impairment Before Atrial Fibrillation–Related Ischemic Events:Neuroimaging and Prognostic Associations

Banerjee, Gargi and Chan, Edgar and Ambler, Gareth and Wilson, Duncan and Cipolotti, Lisa and Shakeshaft, Clare and Cohen, Hannah and Yousry, Tarek and Al-Shahi Salman, Rustam and Lip, Gregory Y.H. and Muir, Keith W. and Brown, Martin M. and Jäger, Hans Rolf and Werring, David J. and Shaw, Louise and Harkness, Kirsty and Sword, Jane and Nor, Azlisham Mohd 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 (2020) Cognitive Impairment Before Atrial Fibrillation–Related Ischemic Events:Neuroimaging and Prognostic Associations. Journal of the American Heart Association, 9 (1). ISSN 2047-9980

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Abstract

Background: It is likely that a proportion of poststroke cognitive impairment is sometimes attributable to unidentified prestroke decline; prestroke cognitive function is also clinically relevant because it is associated with poor functional outcomes, including death. We investigated the radiological and prognostic associations of preexisting cognitive impairment in patients with ischemic stroke or transient ischemic attack associated with atrial fibrillation. Methods and Results: We included 1102 patients from the prospective multicenter observational CROMIS-2 (Clinical Relevance of Microbleeds in Stroke 2) atrial fibrillation study. Preexisting cognitive impairment was identified using the 16-item Informant Questionnaire for Cognitive Decline in the Elderly. Functional outcome was measured using the modified Rankin scale. Preexisting cognitive impairment was common (n=271; 24.6%). The presence of lacunes (odds ratio [OR], 1.50; 95% CI, 1.03–1.05; P=0.034), increasing periventricular white matter hyperintensity grade (per grade increase, OR, 1.38; 95% CI, 1.17–1.63; P<0.0001), deep white matter hyperintensity grade (per grade increase, OR, 1.26; 95% CI, 1.05–1.51; P=0.011), and medial temporal atrophy grade (per grade increase, OR, 1.61; 95% CI, 1.34–1.95; P<0.0001) were independently associated with preexisting cognitive impairment. Preexisting cognitive impairment was associated with poorer functional outcome at 24 months (mRS >2; adjusted OR, 2.43; 95% CI, 1.42–4.20; P=0.001). Conclusions: Preexisting cognitive impairment in patients with atrial fibrillation–associated ischemic stroke or transient ischemic attack is common, and associated with imaging markers of cerebral small vessel disease and neurodegeneration, as well as with longer-term functional outcome. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02513316.

Item Type:
Journal Article
Journal or Publication Title:
Journal of the American Heart Association
Uncontrolled Keywords:
/dk/atira/pure/subjectarea/asjc/2700/2705
Subjects:
ID Code:
146859
Deposited By:
Deposited On:
03 Sep 2020 11:20
Refereed?:
Yes
Published?:
Published
Last Modified:
15 Sep 2020 05:16