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

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Effect of small-vessel disease on cognitive trajectory after atrial fibrillation-related ischaemic stroke or TIA. / The CROMIS-2 collaborators.

In: Journal of Neurology , Vol. 266, No. 5, 01.05.2019, p. 1250-1259.

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The CROMIS-2 collaborators. / Effect of small-vessel disease on cognitive trajectory after atrial fibrillation-related ischaemic stroke or TIA. In: Journal of Neurology . 2019 ; Vol. 266, No. 5. pp. 1250-1259.

Bibtex

@article{40e6a51c9d4a49df81556e4b7faecd1f,
title = "Effect of small-vessel disease on cognitive trajectory after atrial fibrillation-related ischaemic stroke or TIA",
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)",
author = "{The CROMIS-2 collaborators} and Gargi Banerjee and Edgar Chan and Gareth Ambler and Duncan Wilson and Lisa Cipolotti and Clare Shakeshaft and Hannah Cohen and Tarek Yousry and Lip, {Gregory Y.H.} and Muir, {Keith W.} and Brown, {Martin M.} and J{\"a}ger, {Hans Rolf} and Werring, {David J.} and Rustam Al-Shahi Salman and Louise Shaw and Kirsty Harkness and Jane Sword and Azlisham Mohd Nor and Pankaj Sharma and Deborah Kelly and Frances Harrington and Marc Randall and Matthew Smith and Karim Mahawish and Abduelbaset Elmarim and Bernard Esisi and Claire Cullen and Arumug Nallasivam and Christopher Price and Adrian Barry and Christine Roffe and John Coyle and Ahamad Hassan and Caroline Lovelock and Jonathan Birns and David Cohen and L. Sekaran and Adrian Parry-Jones and Anthea Parry and David Hargroves and Harald Proschel and Prabel Datta and Khaled Darawil and Aravindakshan Manoj and Mathew Burn and Chris Patterson and Elio Giallombardo and Nigel Smyth and Syed Mansoor and Hedley Emsley",
year = "2019",
month = may,
day = "1",
doi = "10.1007/s00415-019-09256-6",
language = "English",
volume = "266",
pages = "1250--1259",
journal = "Journal of Neurology ",
issn = "0340-5354",
publisher = "D. Steinkopff-Verlag",
number = "5",

}

RIS

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 -