Serial Changes in Cognitive Function Following Transcatheter Aortic Valve Replacement.
Data regarding the mid- to long-term cognitive trajectory of transcatheter aortic valve (TAVR) recipients are scarce.



Changes in global cognition and specific cognitive domains up to 1 year post-TAVR were evaluated.



Fifty-one patients (median age 80.0 [interquartile range: 72.0 to 85.0] years; 37% women) underwent TAVR and prospective assessment of cognitive function using the Montreal Cognitive Assessment (MoCA) at baseline, short-term (30 days), and 1 year post-TAVR. Processing speed and executive cognitive functions were further evaluated with the digit-symbol substitution test (DSST), Trail Making Tests (TMT), and verbal fluency tests at the same time points. Cognitive decline (CD) was determined by changes in mean scores and as a rate using practice-corrected reliable change index (RCI).



The baseline mean total MoCA score was 22.71 ± 3.84. Twenty patients (39.2%) were considered cognitively impaired using a cutoff of <23 of 30 points. Mean total MoCA score improved at short-term post-TAVR and remained stable at 1 year (p = 0.022). On the basis of the RCI of total MoCA score, 4 patients (7.8%) presented with short-term CD, which persisted at 1 year in 1 patient (2.0%). Four patients (7.8%) exhibited cognitive improvement at 1 year, increasing to 15% among those with baseline cognitive impairment. No significant changes were observed over time in the mean DSST, TMT, and verbal fluency test scores. On the basis of the RCI, 10 of 40 patients (25%) presented with a reduction in performance of at least 1 test at 30 days that persisted at 1 year in 4 patients (10%).



TAVR was associated with global improvement in cognitive status, more pronounced among those with cognitive impairment pre-TAVR. However, early decline in some complex cognitive functions was observed in one-quarter of TAVR recipients, persisting at 1 year in 10% of patients.
Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
Vincent
V
Auffret
Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
Francisco
F
Campelo-Parada
Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
Ander
A
Regueiro
Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
María
M
Del Trigo
Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
Olivier
O
Chiche
Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
Chekrallah
C
Chamandi
Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
Ricardo
R
Allende
Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
Juan G
JG
Cordoba-Soriano
Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
Jean-Michel
JM
Paradis
Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
Robert
R
De Larochellière
Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
Daniel
D
Doyle
Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
Eric
E
Dumont
Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
Siamak
S
Mohammadi
Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
Mélanie
M
Côté
Department of Neurology, University Hospital Georges. L. Dumont, Moncton, New Brunswick, Canada.
Alier
A
Marrero
Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
Rishi
R
Puri
Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada. Electronic address: josep.rodes@criucpq.ulaval.ca.
Josep
J
Rodés-Cabau
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000601:surgery*; D003071:Cognition / Q000502:physiology*; D060825:Cognitive Dysfunction / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*
aortic stenosis; cerebral embolization; cognition; dementia; stroke