title: Evolution of Cognitive Function After Transcatheter Aortic Valve Implantation.
abstract: BACKGROUND
  This study aimed to assess the evolution of cognitive function after transcatheter aortic valve implantation (TAVI). Previous smaller studies reported conflicting results on the evolution of cognitive function after TAVI.
  
  
  RESULTS
  In this prospective cohort, cognitive function was measured in 229 patients ≥70 years using the Mini Mental State Examination before and 6 months after TAVI. Cognitive deterioration or improvement was defined as change of ≥3 points decrease or increase in the Mini Mental State Examination score between baseline and follow-up. Cognitive deterioration was found in 29 patients (12.7%). Predictive analysis using logistic regression did not identify any statistically significant predictor of cognitive deterioration. A review of individual medical records in 8 patients with a major Mini Mental State Examination score decrease of ≥5 points revealed specific causes in 6 cases (postinterventional delirium in 2; postinterventional stroke, progressive renal failure, progressive heart failure, or combination of preexisting cerebrovascular disease and mild cognitive impairment in 1 each). Among 48 patients with impaired baseline cognition (Mini Mental State Examination score <26 points), 18 patients (37.5%) cognitively improved. The preinterventional aortic valve area was lower in patients who cognitively improved (median aortic valve area 0.60 cm2) as compared with patients who did not improve (median aortic valve area 0.70 cm2; P=0.01).
  
  
  CONCLUSIONS
  This is the first study providing evidence that TAVI results in cognitive improvement among patients who had impaired preprocedural cognitive function, possibly related to hemodynamic improvement in patients with severe aortic stenosis. Our results confirm that some patients experience cognitive deterioration after TAVI.
authors.affiliation: From the Department of Geriatrics, Inselspital, Bern University Hospital, and University of Bern, Switzerland (A.W.S., C.Z., A.M., A.E.S.); Institute of Social and Preventive Medicine, University of Bern, Switzerland (A.M., M.Z.); Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (P.W., S.W., S.S.); and Department of Cardiovascular Surgery, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (T.C.). Andreas.Schoenenberger@insel.ch.
authors.forename: Andreas W
authors.initials: AW
authors.lastname: Schoenenberger
authors.affiliation: From the Department of Geriatrics, Inselspital, Bern University Hospital, and University of Bern, Switzerland (A.W.S., C.Z., A.M., A.E.S.); Institute of Social and Preventive Medicine, University of Bern, Switzerland (A.M., M.Z.); Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (P.W., S.W., S.S.); and Department of Cardiovascular Surgery, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (T.C.).
authors.forename: Chantal
authors.initials: C
authors.lastname: Zuber
authors.affiliation: From the Department of Geriatrics, Inselspital, Bern University Hospital, and University of Bern, Switzerland (A.W.S., C.Z., A.M., A.E.S.); Institute of Social and Preventive Medicine, University of Bern, Switzerland (A.M., M.Z.); Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (P.W., S.W., S.S.); and Department of Cardiovascular Surgery, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (T.C.).
authors.forename: André
authors.initials: A
authors.lastname: Moser
authors.affiliation: From the Department of Geriatrics, Inselspital, Bern University Hospital, and University of Bern, Switzerland (A.W.S., C.Z., A.M., A.E.S.); Institute of Social and Preventive Medicine, University of Bern, Switzerland (A.M., M.Z.); Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (P.W., S.W., S.S.); and Department of Cardiovascular Surgery, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (T.C.).
authors.forename: Marcel
authors.initials: M
authors.lastname: Zwahlen
authors.affiliation: From the Department of Geriatrics, Inselspital, Bern University Hospital, and University of Bern, Switzerland (A.W.S., C.Z., A.M., A.E.S.); Institute of Social and Preventive Medicine, University of Bern, Switzerland (A.M., M.Z.); Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (P.W., S.W., S.S.); and Department of Cardiovascular Surgery, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (T.C.).
authors.forename: Peter
authors.initials: P
authors.lastname: Wenaweser
authors.affiliation: From the Department of Geriatrics, Inselspital, Bern University Hospital, and University of Bern, Switzerland (A.W.S., C.Z., A.M., A.E.S.); Institute of Social and Preventive Medicine, University of Bern, Switzerland (A.M., M.Z.); Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (P.W., S.W., S.S.); and Department of Cardiovascular Surgery, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (T.C.).
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.affiliation: From the Department of Geriatrics, Inselspital, Bern University Hospital, and University of Bern, Switzerland (A.W.S., C.Z., A.M., A.E.S.); Institute of Social and Preventive Medicine, University of Bern, Switzerland (A.M., M.Z.); Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (P.W., S.W., S.S.); and Department of Cardiovascular Surgery, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (T.C.).
authors.forename: Thierry
authors.initials: T
authors.lastname: Carrel
authors.affiliation: From the Department of Geriatrics, Inselspital, Bern University Hospital, and University of Bern, Switzerland (A.W.S., C.Z., A.M., A.E.S.); Institute of Social and Preventive Medicine, University of Bern, Switzerland (A.M., M.Z.); Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (P.W., S.W., S.S.); and Department of Cardiovascular Surgery, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (T.C.).
authors.forename: Andreas E
authors.initials: AE
authors.lastname: Stuck
authors.affiliation: From the Department of Geriatrics, Inselspital, Bern University Hospital, and University of Bern, Switzerland (A.W.S., C.Z., A.M., A.E.S.); Institute of Social and Preventive Medicine, University of Bern, Switzerland (A.M., M.Z.); Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (P.W., S.W., S.S.); and Department of Cardiovascular Surgery, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (T.C.).
authors.forename: Stefan
authors.initials: S
authors.lastname: Stortecky
keywords: aortic valve stenosis; cognition; geriatric assessment; heart failure; transcatheter aortic valve replacement