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

Banerjee, G. et al. (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. (doi: 10.1007/s00415-019-09256-6) (PMID:30847646) (PMCID:PMC6469837)

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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:Articles
Additional Information:The CROMIS-2 study is funded by the Stroke Association and British Heart Foundation. GB holds an NIHR Academic Clinical Fellowship, and received funding from the Rosetrees Trust. GA receives funding from the NIHR University College London Hospitals Biomedical Research Centre. RASS is funded by an MRC senior clinical fellowship. MMB’s Chair in Stroke Medicine is supported by the Reta Lila Weston Trust for Medical Research. DJW receives research support from the Stroke Association, the British Heart Foundation and the Rosetrees Trust. This work was undertaken at UCLH/UCL which receives a proportion of funding from the Department of Health’s NIHR Biomedical Research Centres funding scheme.
Glasgow Author(s) Enlighten ID:Muir, Professor Keith
Authors: Banerjee, G., Chan, E., Ambler, G., Wilson, D., Cipolotti, L., Shakeshaft, C., Cohen, H., Yousry, T., Lip, G. Y.H., Muir, K. W., Brown, M. M., Jäger, H. R., and Werring, D. J.
College/School:College of Medical Veterinary and Life Sciences > School of Psychology & Neuroscience
Journal Name:Journal of Neurology
ISSN (Online):1432-1459
Published Online:07 March 2019
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in Journal of Neurology 266(5):1250-1259
Publisher Policy:Reproduced under a Creative Commons License

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