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
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TY - JOUR
T1 - Effect of small-vessel disease on cognitive trajectory after atrial fibrillation-related ischaemic stroke or TIA
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 - Lip, Gregory Y.H.
AU - Muir, Keith W.
AU - Brown, Martin M.
AU - Jäger, Hans Rolf
AU - Werring, David J.
AU - Al-Shahi Salman, Rustam
AU - Shaw, Louise
AU - Harkness, Kirsty
AU - Sword, Jane
AU - Mohd Nor, Azlisham
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 - 2019/5/1
Y1 - 2019/5/1
N2 - 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.
AB - 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.
KW - Atrial fibrillation
KW - Brain ischaemia
KW - Cerebral small-vessel disease
KW - Cognitive impairment
KW - Ischaemic stroke
KW - Transient ischaemic attack (TIA)
U2 - 10.1007/s00415-019-09256-6
DO - 10.1007/s00415-019-09256-6
M3 - Journal article
C2 - 30847646
AN - SCOPUS:85062767455
VL - 266
SP - 1250
EP - 1259
JO - Journal of Neurology
JF - Journal of Neurology
SN - 0340-5354
IS - 5
ER -