Serial Changes in Cognitive Function Following Transcatheter Aortic Valve Replacement

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• 作者：Vincent Auffret ; MD ; MSc^a ; Francisco Campelo-Parada ; MD^a ; Ander Regueiro ; MD^a ; Marí ; a Del Trigo ; MD^a ; Olivier Chiche ; MD^a ; Chekrallah Chamandi ; MD^a ; Ricardo Allende ; MD^a ; Juan G. Cordoba-Soriano ; MD^a ; Jean-Michel Paradis ; MD^a ; Robert De Larochelliè ; re ; MD^a ; Daniel Doyle ; MD^a ; Eric Dumont ; MD^a ; Siamak Mohammadi ; MD^a ; Mé ; lanie Cô ; té ; MSc^a ; Alier Marrero ; MD^b ; Rishi Puri ; MBBS ; PhD^a ; Josep Rodé ; s-Cabau ; MD^a ; ^{josep.rodes@criucpq.ulaval.ca" class="auth_mail" title="E-mail the corresponding author}
• 关键词：aortic stenosis ; cerebral embolization ; cognition ; dementia ; stroke
• 刊名：Journal of the American College of Cardiology
• 出版年：2016
• 出版时间：15-22 November 2016
• 年：2016
• 卷：68
• 期：20
• 页码：2129-2141
• 全文大小：956 K

文摘

Data regarding the mid- to long-term cognitive trajectory of transcatheter aortic valve (TAVR) recipients are scarce.

Objectives

Changes in global cognition and specific cognitive domains up to 1 year post-TAVR were evaluated.

Methods

Fifty-one patients (median age 80.0 [interquartile range: 72.0 to 85.0] years; 37% women) underwent TAVR and prospective assessment of cognitive function using the Montreal Cognitive Assessment (MoCA) at baseline, short-term (30 days), and 1 year post-TAVR. Processing speed and executive cognitive functions were further evaluated with the digit-symbol substitution test (DSST), Trail Making Tests (TMT), and verbal fluency tests at the same time points. Cognitive decline (CD) was determined by changes in mean scores and as a rate using practice-corrected reliable change index (RCI).

Results

The baseline mean total MoCA score was 22.71 ± 3.84. Twenty patients (39.2%) were considered cognitively impaired using a cutoff of <23 of 30 points. Mean total MoCA score improved at short-term post-TAVR and remained stable at 1 year (p = 0.022). On the basis of the RCI of total MoCA score, 4 patients (7.8%) presented with short-term CD, which persisted at 1 year in 1 patient (2.0%). Four patients (7.8%) exhibited cognitive improvement at 1 year, increasing to 15% among those with baseline cognitive impairment. No significant changes were observed over time in the mean DSST, TMT, and verbal fluency test scores. On the basis of the RCI, 10 of 40 patients (25%) presented with a reduction in performance of at least 1 test at 30 days that persisted at 1 year in 4 patients (10%).

Conclusions

TAVR was associated with global improvement in cognitive status, more pronounced among those with cognitive impairment pre-TAVR. However, early decline in some complex cognitive functions was observed in one-quarter of TAVR recipients, persisting at 1 year in 10% of patients.