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. 2022 Aug 5;14(15):6111-6127.
doi: 10.18632/aging.204202. Epub 2022 Aug 5.

Serial neurocognitive changes following transcatheter aortic valve replacement: comparison between low and intermediate-high risk groups

Tsung-Yu Ko  1   2 , Hsien-Li Kao  1 , Chih-Fan Yeh  1 , Jiu-Hsiang Lin  3 , Ching-Chang Huang  1 , Ying-Hsien Chen  1 , Chi-Chao Chao  4 , Hung-Yuan Li  1 , Chih-Yang Chan  5 , Lung-Chun Lin  1 , Yih-Sharng Chen  5 , Ming-Jiuh Wang  6 , Mao-Shin Lin  1
Affiliations

Serial neurocognitive changes following transcatheter aortic valve replacement: comparison between low and intermediate-high risk groups

Tsung-Yu Ko et al. Aging (Albany NY). .

Abstract

Background: Data comparing the neurocognitive trajectory between low and intermediate-high risk patients following transcatheter aortic valve replacement (TAVR) is never reported.

Aims: To report serial neurocognitive changes up to 1 year post-TAVR in low and intermediate-high risk groups as well as overall cohort.

Methods: Prospective neurological assessments (NIHSS and Barthel Index), global cognitive tests (MMSE and Alzheimer Disease Assessment Scale-Cognitive Subtest, ADAS-cog) and executive performances (Color Trail Test A and B and verbal fluency), were applied at baseline, 3 months and 1 year post-TAVR.

Results: In overall cohort, persistent improvement to 1 year in MMSE, ADAS-cog, Color Trail Test A and B was found. According to the STS score, the study cohort was divided into low (<4%, N = 81) and intermediate-high (≧4%, N = 75) risk groups. The baseline neurologic and cognitive performance was significantly worse in intermediate-high risk group. Slight improvement on general neurological functions (Barthel index and proportion of NIHSS>0 patients) at 1 year could be observed only in intermediate-high risk group. In global cognitive assessments, improvement in MMSE and ADAS-cog at 1 year was found in both groups, but the proportion of cognitive improvement was more obvious in intermediate-high risk group. In Color Trail Tests and verbal fluency, significant and persistent improvement up to 1 year could be observed only in low risk group.

Conclusions: TAVR was associated with persistent improvement in global cognitive function, as well as in attention and psychomotor processing speed, up to 1 year in overall cohort. However, improvement in tests for executive functions can only be seen in low risk group.

Keywords: TAVR; aortic stenosis; neurocognitive function.

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Conflict of interest statement

CONFLICTS OF INTEREST: The authors declare no conflicts of interest related to this study.

Figures

Figure 1
Figure 1
Study flow chart outlining recruitment and grouping for patients depending on STS-PROM. Abbreviations: TAVR: Transcatheter Aortic Valve Replacement; STS-PROM: Society of Thoracic Surgeons Predicted Risk of Mortality.
Figure 2
Figure 2
Percentage of patients with changes in MMSE and ADAS-cog. Deterioration or improvement was defined as change of ≥3 points decrease or increase in the MMSE score. (A) Baseline to 3 months. (B) Baseline to 1 year. Deterioration or improvement was defined as change of ≥3 points increase or decrease in the ADAS-cog score. (C) Baseline to 3 months. (D) Baseline to 1 year. Abbreviations: MMSE: Mini-Mental State Examination score; ADAS-cog: Alzheimer Disease Assessment Scale–Cognitive Subtest.
Figure 3
Figure 3
Evolution of the percentage of cognitive category in color trails test A and B over time. (A) Color Tails Test A in intermediate-high risk group. (B) Color Tails Test A in low-risk group. (C) Color Tails Test B in intermediate-high risk group. (D) Color Tails Test B in low-risk group.
Figure 4
Figure 4
Evolution of mean score of verbal fluency over time by groups. (A) Intermediate-high risk group. (B) Low risk group.
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