Cognitive Impairment Before Atrial Fibrillation–Related Ischemic Events: Neuroimaging and Prognostic Associations
Authors: Banerjee Gargi , Chan Edgar , Ambler Gareth , Wilson Duncan , Cipolotti Lisa , Shakeshaft Clare , Cohen Hannah , Yousry Tarek , Al‐Shahi Salman Rustam , Lip Gregory Y. H. , Muir Keith W. , Brown Martin M. , Jäger Hans Rolf , Werring David J. , Shaw Louise , Harkness Kirsty , Sword Jane , Nor Azlisham Mohd , Sharma Pankaj , Kelly Deborah , Harrington Frances , Randall Marc , Smith Matthew , Mahawish Karim , Elmarim Abduelbaset , Esisi Bernard , Cullen Claire , Nallasivam Arumug , Price Christopher , Barry Adrian , Roffe Christine , Coyle John , Hassan Ahamad , Lovelock Caroline , Birns Jonathan , Cohen David , Sekaran L. , Parry‐Jones Adrian , Parry Anthea , Hargroves David , Proschel Harald , Datta Prabel , Darawil Khaled , Manoj Aravindakshan , Burn Mathew , Patterson Chris , Giallombardo Elio , Smyth Nigel , Mansoor Syed , Anwar Ijaz , Marsh Rachel , Ispoglou Sissi , Chadha Dinesh , Prabhakaran Mathuri , Meenakishundaram Sanjeevikumar , O'Connell Janice , Scott Jon , Krishnamurthy Vinodh , Aghoram Prasanna , McCormick Michael , O'Mahony Paul , Cooper Martin , Choy Lillian , Wilkinson Peter , Leach Simon , Caine Sarah , Burger Ilse , Gunathilagan Gunaratam , Guyler Paul , Emsley Hedley , Davis Michelle , Manawadu Dulka , Pasco Kath , Mamun Maam , Luder Robert , Sajid Mahmud , Anwar Ijaz , Okwera James , Staals Julie , Warburton Elizabeth , Saastamoinen Kari , England Timothy , Putterill Janet , Flossman Enrico , Power Michael , Dani Krishna , Mangion David , Suman Appu , Corrigan John , Lawrence Enas , Vahidassr Djamil 
Published: January 2020

Background
It is likely that a proportion of poststroke cognitive impairment is sometimes attributable to unidentified prestroke decline; prestroke cognitive function is also clinically relevant because it is associated with poor functional outcomes, including death. We investigated the radiological and prognostic associations of preexisting cognitive impairment in patients with ischemic stroke or transient ischemic attack associated with atrial fibrillation.

Methods and Results

We included 1102 patients from the prospective multicenter observational
CROMIS
‐2 (Clinical Relevance of Microbleeds in Stroke 2) atrial fibrillation study. Preexisting cognitive impairment was identified using the 16‐item Informant Questionnaire for Cognitive Decline in the Elderly. Functional outcome was measured using the modified Rankin scale. Preexisting cognitive impairment was common (n=271; 24.6%). The presence of lacunes (odds ratio [OR], 1.50; 95%
CI
, 1.03–1.05;
P
=0.034), increasing periventricular white matter hyperintensity grade (per grade increase,
OR
, 1.38; 95%
CI
, 1.17–1.63;
P
<0.0001), deep white matter hyperintensity grade (per grade increase,
OR
, 1.26; 95%
CI
, 1.05–1.51;
P
=0.011), and medial temporal atrophy grade (per grade increase,
OR
, 1.61; 95%
CI
, 1.34–1.95;
P
<0.0001) were independently associated with preexisting cognitive impairment. Preexisting cognitive impairment was associated with poorer functional outcome at 24 months (
mRS
>2; adjusted
OR
, 2.43; 95%
CI
, 1.42–4.20;
P
=0.001).

Conclusions
Preexisting cognitive impairment in patients with atrial fibrillation–associated ischemic stroke or transient ischemic attack is common, and associated with imaging markers of cerebral small vessel disease and neurodegeneration, as well as with longer‐term functional outcome.

Clinical Trial Registration

URL
:
http://www.clinicaltrials.gov
. Unique identifier:
NCT
02513316.