Cognitive Impairment Before Atrial Fibrillation–Related Ischemic Events: Neuroimaging and Prognostic Associations. Issue 1 (7th January 2020)

• Record Type: Journal Article
• Authors: Banerjee, Gargi; Chan, Edgar; Ambler, Gareth; Wilson, Duncan; Cipolotti, Lisa; Shakeshaft, Clare; Cohen, Hannah; Yousry, Tarek; Al‐Shahi Salman, Rustam; Lip, Gregory Y. H.; Muir, Keith W.; Brown, Martin M.; Jäger, Hans Rolf; Werring, David J.
• Other Names: Shaw Louise investigator.; Harkness Kirsty investigator.; Sword Jane investigator.; Nor Azlisham Mohd investigator.; Sharma Pankaj investigator.; Kelly Deborah investigator.; Harrington Frances investigator.; Randall Marc investigator.; Smith Matthew investigator.; Mahawish Karim investigator.; Elmarim Abduelbaset investigator.; Esisi Bernard investigator.; Cullen Claire investigator.; Nallasivam Arumug investigator.; Price Christopher investigator.; Barry Adrian investigator.; Roffe Christine investigator.; Coyle John investigator.; Hassan Ahamad investigator.; Lovelock Caroline investigator.; Birns Jonathan investigator.; Cohen David investigator.; Sekaran L. investigator.; Parry‐Jones Adrian investigator.; Parry Anthea investigator.; Hargroves David investigator.; Proschel Harald investigator.; Datta Prabel investigator.; Darawil Khaled investigator.; Manoj Aravindakshan investigator.; Burn Mathew investigator.; Patterson Chris investigator.; Giallombardo Elio investigator.; Smyth Nigel investigator.; Mansoor Syed investigator.; Anwar Ijaz investigator.; Marsh Rachel investigator.; Ispoglou Sissi investigator.; Chadha Dinesh investigator.; Prabhakaran Mathuri investigator.; Meenakishundaram Sanjeevikumar investigator.; O'Connell Janice investigator.; Scott Jon investigator.; Krishnamurthy Vinodh investigator.; Aghoram Prasanna investigator.; McCormick Michael investigator.; O'Mahony Paul investigator.; Cooper Martin investigator.; Choy Lillian investigator.; Wilkinson Peter investigator.; Leach Simon investigator.; Caine Sarah investigator.; Burger Ilse investigator.; Gunathilagan Gunaratam investigator.; Guyler Paul investigator.; Emsley Hedley investigator.; Davis Michelle investigator.; Manawadu Dulka investigator.; Pasco Kath investigator.; Mamun Maam investigator.; Luder Robert investigator.; Sajid Mahmud investigator.; Anwar Ijaz investigator.; Okwera James investigator.; Staals Julie investigator.; Warburton Elizabeth investigator.; Saastamoinen Kari investigator.; England Timothy investigator.; Putterill Janet investigator.; Flossman Enrico investigator.; Power Michael investigator.; Dani Krishna investigator.; Mangion David investigator.; Suman Appu investigator.; Corrigan John investigator.; Lawrence Enas investigator.; Vahidassr Djamil investigator.;
• Is Part Of: Journal of the American Heart Association. Volume 9:Issue 1(2020)
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• Page End: n/a
• Publication Date: 2020-01-07
• Subjects: atrial fibrillation -- brain ischemia -- cerebral small vessel disease -- cognitive impairment -- vascular dementia; Heart -- Diseases -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; Cerebrovascular disease -- Periodicals; Cardiology -- Periodicals; 616.1
• DOI: 10.1161/JAHA.119.014537
• Languages: English
• ISSNs: 2047-9980

Abstract

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. Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT02513316.