title: Cognitive trajectory after transcatheter aortic valve implantation.
abstract: BACKGROUND
  Transcatheter aortic valve implantation (TAVI) is known to be associated with silent cerebral injury, which could contribute to cognitive impairment. Considering its increasing use, thorough longitudinal investigation of cognitive trajectory after TAVI is pivotal.
  
  
  RESULTS
  Repeatable battery for the assessment of neuropsychological status was performed before (E1), 3 days (E2), 3 months (E3), 1 (E4) year, and 2 years (E5) after TAVI. Baseline characteristics, procedural data, imaging parameters of brain injury (diffusion-weighted MRI), and the use of conceivable neuroprotective approaches were investigated for their effect on cognitive function. Cognitive performance was investigated in 111 patients (mean log EuroSCORE, 30±13%). Global cognitive function (repeatable battery for the assessment of neuropsychological status total score) increased transiently at E2 (P=0.02) and was comparable with baseline levels at E3, E4, and E5. Six patients (5.4%) demonstrated early cognitive decline. Persistence and late onset were seen infrequently (n=3, 2.7% and n=4, 3.6%, respectively). Hence, early cognitive decline was ruled out in 105 patients (94.6%), and a majority of patients (91%) demonstrated sustained cognitive performance throughout all investigated time points. Interestingly, only patient age (P=0.012), but not prior cerebrovascular events, cognitive status, direct TAVI, cerebral embolism in diffusion-weighted MRI, or the use of a cerebral embolic protection device was found to be independently associated with cognitive decline, linking higher age to cognitive impairment along the first 2 years after TAVI.
  
  
  CONCLUSIONS
  Long-term cognitive performance was preserved in the great majority (91%) of patients throughout the first 2 years after TAVI, despite the high intrinsic risk for cognitive deterioration.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00883285.
authors.affiliation: From the Department of Medicine/Cardiology (A.G., J.K., J.-M.S., B.V.B., M.V., T.S., M.V.-N., C.H., J.O.S., N.W., E.G., G.N.), Department of Psychiatry and Psychotherapy (M.W., S.W.), and Department of Radiology (D.T., A.M.), University of Bonn, Bonn, Germany; and German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany (M.W., S.W.).
authors.forename: Alexander
authors.initials: A
authors.lastname: Ghanem
authors.forename: Justine
authors.initials: J
authors.lastname: Kocurek
authors.forename: Jan-Malte
authors.initials: JM
authors.lastname: Sinning
authors.forename: Michael
authors.initials: M
authors.lastname: Wagner
authors.forename: Benjamin V
authors.initials: BV
authors.lastname: Becker
authors.forename: Marieke
authors.initials: M
authors.lastname: Vogel
authors.forename: Thomas
authors.initials: T
authors.lastname: Schröder
authors.forename: Steffen
authors.initials: S
authors.lastname: Wolfsgruber
authors.forename: Mariuca
authors.initials: M
authors.lastname: Vasa-Nicotera
authors.forename: Christoph
authors.initials: C
authors.lastname: Hammerstingl
authors.forename: Jörg O
authors.initials: JO
authors.lastname: Schwab
authors.forename: Daniel
authors.initials: D
authors.lastname: Thomas
authors.forename: Nikos
authors.initials: N
authors.lastname: Werner
authors.forename: Eberhard
authors.initials: E
authors.lastname: Grube
authors.forename: Georg
authors.initials: G
authors.lastname: Nickenig
authors.forename: Andreas
authors.initials: A
authors.lastname: Müller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D006328:Cardiac Catheterization / Q000009:adverse effects*; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000601:surgery*; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D020766:Intracranial Embolism / Q000150:complications / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D009483:Neuropsychological Tests; D012307:Risk Factors; D016896:Treatment Outcome
keywords: TAVR; cognition; dementia; injury; intracranial embolism; mild cognitive impairment; stroke