Cognitive impairment prior to atrial fibrillation–related ischaemic events: neuroimaging and prognostic associations

Banerjee, G. et al. (2020) Cognitive impairment prior to atrial fibrillation–related ischaemic events: neuroimaging and prognostic associations. Journal of the American Heart Association, 9(1), e014537. (doi: 10.1161/JAHA.119.014537) (PMID:31902325) (PMCID:PMC6988157)

[img]
Preview
Text
205533.pdf - Published Version
Available under License Creative Commons Attribution.

366kB

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.

Item Type:Articles
Status:Published
Refereed:Yes
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., Habil, M., Al-Shahi Salman, R., Lip, G. Y.H., Muir, K. W., Brown, M. M., Jager, H. R., and Werring, D. J.
College/School:College of Medical Veterinary and Life Sciences > Institute of Neuroscience and Psychology
Journal Name:Journal of the American Heart Association
Publisher:American Heart Association
ISSN:2047-9980
ISSN (Online):2047-9980
Published Online:04 January 2020
Copyright Holders:Copyright © 2020 The Authors
First Published:First published in Journal of the American Heart Association 9(1):e014537
Publisher Policy:Reproduced under a Creative Commons licence

University Staff: Request a correction | Enlighten Editors: Update this record