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. 2019 May;266(5):1250-1259.
doi: 10.1007/s00415-019-09256-6. Epub 2019 Mar 7.

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

Gargi Banerjee  1 , Edgar Chan  2 , Gareth Ambler  3 , Duncan Wilson  1   4 , Lisa Cipolotti  2 , Clare Shakeshaft  1 , Hannah Cohen  5 , Tarek Yousry  6 , Gregory Y H Lip  7   8 , Keith W Muir  9 , Martin M Brown  1 , Hans Rolf Jäger  6 , David J Werring  10 ; CROMIS-2 collaborators
Collaborators, Affiliations

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

Gargi Banerjee et al. J Neurol. 2019 May.

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.

Keywords: Atrial fibrillation; Brain ischaemia; Cerebral small-vessel disease; Cognitive impairment; Ischaemic stroke; Transient ischaemic attack (TIA).

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Conflict of interest statement

HC has received institutional research support from Bayer; honoraria for lectures and an Advisory Board from Bayer, diverted to a local charity; and travel/accommodation expenses for participation in scientific meetings covered by Bayer. GYHL acts as a consultant for Bayer/Janssen, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Novartis, Verseon and Daiichi-Sankyo, and as a speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo; no fees are directly received personally. The remaining authors report no disclosures or conflicts of interest relevant to the manuscript.

Figures

Fig. 1
Fig. 1
Description of study population
Fig. 2
Fig. 2
Distribution of acute and 12 months MoCA scores. Each patient is shown by a single diamond; the data have been jittered to show individual points. The line of equality is shown in red
Fig. 3
Fig. 3
Distribution of acute and 12 months MoCA scores for reverters and non-reverters. Each patient is shown by a single symbol, as indicated by the key; the data have been jittered to show individual points. The line of equality is shown in red
See this image and copyright information in PMC

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