Determinants of Cognitive Impairment After Acute Coronary Syndrome
Condition: Coronary Syndrome
MeSH terms: Acute Coronary Syndrome; Syndrome; Cognitive Dysfunction
Study type: Observational

Summary: 
      The general purpose of the present pathophysiological study is to investigate the relation
      between cognitive impairment observed after an acute coronary syndrome and the presence of
      cerebral anatomo-functional abnormalities. This study will improve the investigators'
      understanding of the disease and will help in early diagnosis and prevention of vascular
      dementia in this population.
    

Detailed description: 
      Cognitive impairment is observed in more than 30% of the patients from 3 to 6 months after an
      acute coronary syndrome. Executive functions are mainly impaired. Cognition tends to
      progressively deteriorate during the following years, therefore increasing the risk of
      vascular dementia. Increased age and low educational level are the main risks factors whereas
      the risk is not modified by the strategy used to obtain a coronary revascularization. Brain
      imaging studies have demonstrated a vascular leukoencephalopathy in 50% of the patients with
      a previous history of ischaemic heart disease. However the link between brain
      anatomo-functional changes and occurrence of cognitive dysfunction remains largely unknown.

      50 patients will be included in this study.

      Cognition will be evaluated using a standard neuropsychological assessment (investigating
      executive function, memory, attention, language and visuo-constructive abilities) and a 7
      days experience sampling method which evaluates cognition in daily life. Brain
      anatomo-functional study will include a brain MRI and two Tc-99m-HMPAO SPECT performed
      respectively with and without intravenous injection of acetazolamide in order to measure
      cerebral blood-flow and cerebrovascular reserve capacity.

      Prospective exploratory study performed in a cohort of patients admitted for evaluation of
      their cardio-vascular risk factor 4 ±1 months after an acute coronary syndrome.

      Patients will be included 4 ± 1 months after a first episode of acute coronary syndrome. A
      standard neuropsychological assessment will be performed by a neuropsychologist at inclusion
      and 6 months later. The daily life experience study will be performed during a period of 7
      consecutive days following the inclusion. Questions will be asked to the patients 5 times a
      day by a pocket computer (Palm). MRI will be performed on a 3 Tesla research MRI. Two
      Tc-99m-HMPAO SPECT studies will be performed, the first one at inclusion and the second one
      more than 2 days and less than 15 days after the first. The second SPECT study will be
      performed after intravenous injection of acetazolamide.

      Relationship between cognitive impairment and brain anatomo-functional abnormalities will be
      investigated using a linear regression model.
    

Intervention name(s): Brain MRI and cerebral perfusion scintigraphy
Intervention type(s): Other
Intervention description(s): A standard neuropsychological assessment will be performed by a neuropsychologist. The daily life experience study will be performed. Questions will be asked to the patients by a pocket computer (Palm).
MRI will be performed on a 3 Tesla research MRI. Two Tc-99m-HMPAO SPECT studies will be performed The second SPECT study will be performed after intravenous injection of acetazolamide.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        a cohort of patients admitted for evaluation of their cardio-vascular risk factor 4 ±1
        months after an acute coronary syndrome
      
Keywords: Anatomo-functional determinants; cognitive impairment; coronary syndrome; brain MRI; cerebral perfusion scintigraphy