Atrial fibrillation-related stroke: cerebral small-vessel disease tied to cognitive deficits

  • Banerjee G & al.
  • J Neurol
  • 7 Mar 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Montreal Cognitive Assessment (MoCA)-defined cognitive impairment 12 months following an ischaemic event is common.
  • In patients with atrial fibrillation (Afib)-related acute ischaemic stroke or transient ischaemic attacks (TIAs), cerebral small-vessel disease is associated with cognitive deficits and a lack of improvement at 12 months.

Why this matters

  • Post-stroke dementia is common but has heterogenous mechanisms that are not fully understood, particularly in patients with Afib-related ischaemic stroke or TIA.
  • The contribution of small-vessel diseases to post-stroke dementia in patients with Afib-related ischaemic stroke or TIA remains unknown.

Study design

  • This study included 117 patients (age, ≥18 years) presenting with ischaemic cardioembolic stroke or TIA with non-valvular afib without cognitive impairment and with MoCA data from the Clinical Relevance of Microbleeds In Stroke-2 Afib (CROMIS-2 Afib) study.
  • MoCA score
  • Funding: Stroke Association and British Heart Foundation.

Key results

  • Overall, there was significant improvement in MoCA score at 12 months (mean difference, 1.69 points; 95% CI, 1.03-2.36; P<.00001>
  • Cognitive impairment at 12 months was linked to increased cerebral amyloid score (CAA) (adjusted OR [aOR], 4.09; P=.012).
  • Of 66 patients with abnormal MoCA score, 39 (59.1%) were “reverters.”
  • Non-reversion was positively associated with:
    • centrum semi-ovale perivascular spaces (aOR, 1.96; P=.035).
    • cerebral microbleeds (aOR, 9.36; P=.059),
  • Multiple ischaemic lesions at baseline (aOR, 0.11; P=.051), composite small-vessel disease (aOR, 2.47; P=.046) and CAA (aOR, 6.70; P=.003) scores were negatively associated with non-reversion.

Limitations

  • Only a subset of centres collected 12-month MoCA data.