Final published version
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Research output: Contribution to Journal/Magazine › Journal article › peer-review
Research output: Contribution to Journal/Magazine › Journal article › peer-review
}
TY - JOUR
T1 - Cognitive Impairment Before Atrial Fibrillation–Related Ischemic Events
T2 - Neuroimaging and Prognostic Associations
AU - The CROMIS-2 collaborators
AU - Banerjee, Gargi
AU - Chan, Edgar
AU - Ambler, Gareth
AU - Wilson, Duncan
AU - Cipolotti, Lisa
AU - Shakeshaft, Clare
AU - Cohen, Hannah
AU - Yousry, Tarek
AU - Al-Shahi Salman, Rustam
AU - Lip, Gregory Y.H.
AU - Muir, Keith W.
AU - Brown, Martin M.
AU - Jäger, Hans Rolf
AU - Werring, David J.
AU - Shaw, Louise
AU - Harkness, Kirsty
AU - Sword, Jane
AU - Nor, Azlisham Mohd
AU - Sharma, Pankaj
AU - Kelly, Deborah
AU - Harrington, Frances
AU - Randall, Marc
AU - Smith, Matthew
AU - Mahawish, Karim
AU - Elmarim, Abduelbaset
AU - Esisi, Bernard
AU - Cullen, Claire
AU - Nallasivam, Arumug
AU - Price, Christopher
AU - Barry, Adrian
AU - Roffe, Christine
AU - Coyle, John
AU - Hassan, Ahamad
AU - Lovelock, Caroline
AU - Birns, Jonathan
AU - Cohen, David
AU - Sekaran, L.
AU - Parry-Jones, Adrian
AU - Parry, Anthea
AU - Hargroves, David
AU - Proschel, Harald
AU - Datta, Prabel
AU - Darawil, Khaled
AU - Manoj, Aravindakshan
AU - Burn, Mathew
AU - Patterson, Chris
AU - Giallombardo, Elio
AU - Smyth, Nigel
AU - Mansoor, Syed
AU - Emsley, Hedley
PY - 2020/1/7
Y1 - 2020/1/7
N2 - 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.
AB - 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.
KW - atrial fibrillation
KW - brain ischemia
KW - cerebral small vessel disease
KW - cognitive impairment
KW - vascular dementia
U2 - 10.1161/JAHA.119.014537
DO - 10.1161/JAHA.119.014537
M3 - Journal article
C2 - 31902325
AN - SCOPUS:85077480270
VL - 9
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
SN - 2047-9980
IS - 1
M1 - e014537
ER -