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

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Keith W. Muir¹  Hans Rolf Jäger²  Rustam Al‐Shahi Salman³  Gargi Banerjee⁴  Duncan Wilson⁴  David J. Werring⁴  Clare Shakeshaft⁴  Lisa Cipolotti⁵  Edgar Chan⁵  Gareth Ambler⁶  Hannah Cohen⁷  Martin M. Brown⁸  Gregory Y. H. Lip⁹  Tarek Yousry^1,10 

[1] Chest Hospital Liverpool United Kingdom;Psychology Queen Elizabeth University Hospital University of Glasgow United Kingdom;Centre for Clinical Brain Sciences School of Clinical Sciences University of Edinburgh United Kingdom;Department of Brain Repair and Rehabilitation Stroke Research Centre UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery London United Kingdom;Department of Neuropsychology National Hospital for Neurology and Neurosurgery Queen Square London United Kingdom;Department of Statistical Science University College London London United Kingdom;Haemostasis Research Unit Department of Haematology University College London London United Kingdom;;Institute of Neuroscience &;Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart &Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit Department of Brain Repair and Rehabilitation UCL Queen Square Institute of Neurology Queen Square London United Kingdom;

关键词: atrial fibrillation;    brain ischemia;    cerebral small vessel disease;    cognitive impairment;    vascular dementia;   

DOI  :  10.1161/JAHA.119.014537

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown