title: Cognitive Outcomes following Transcatheter Aortic Valve Implantation: A Systematic Review.
abstract: Severe aortic stenosis is the most common valvular heart disease in the elderly in the Western world and contributes to a large proportion of all deaths over the age of 70. Severe aortic stenosis is conventionally treated with surgical aortic valve replacement; however, the less invasive transcatheter aortic valve implantation (TAVI) is suggested for those at high surgical risk. While TAVI has been associated with improved survival and favourable outcomes, there is a higher incidence of cerebral microembolisms in TAVI patients. This finding is of concern given mechanistic links with cognitive decline, a symptom highly prevalent in those with cardiovascular disease. This paper reviews the literature assessing the possible link between TAVI and cognitive changes. Studies to date have shown that global cognition improves or remains unchanged over 3 months following TAVI while individual cognitive domains remain preserved over time. However, the association between TAVI and cognition remains unclear due to methodological limitations. Furthermore, while these studies have largely focused on memory, cognitive impairment in this population may be predominantly of vascular origin. Therefore, cognitive assessment focusing on domains important in vascular cognitive impairment, such as executive dysfunction, may be more helpful in elucidating the association between TAVI and cognition in the long term.
authors.affiliation: Neuropsychopharmacology Research Group, Sunnybrook Health Sciences Centre, Toronto, ON, Canada M4N 3M5 ; Faculty of Medicine, University of Toronto, Toronto, ON, Canada M5S 1A8.
authors.forename: Ka Sing Paris
authors.initials: KS
authors.lastname: Lai
authors.affiliation: Neuropsychopharmacology Research Group, Sunnybrook Health Sciences Centre, Toronto, ON, Canada M4N 3M5 ; Department of Psychiatry, University of Toronto, Toronto, ON, Canada M5T 1R8.
authors.forename: Nathan
authors.initials: N
authors.lastname: Herrmann
authors.affiliation: Neuropsychopharmacology Research Group, Sunnybrook Health Sciences Centre, Toronto, ON, Canada M4N 3M5 ; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada M5S 1A8.
authors.forename: Mahwesh
authors.initials: M
authors.lastname: Saleem
authors.affiliation: Neuropsychopharmacology Research Group, Sunnybrook Health Sciences Centre, Toronto, ON, Canada M4N 3M5 ; Department of Psychiatry, University of Toronto, Toronto, ON, Canada M5T 1R8 ; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada M5S 1A8.
authors.forename: Krista L
authors.initials: KL
authors.lastname: Lanctôt