Research Paper Advance Articles

Serial neurocognitive changes following transcatheter aortic valve replacement: comparison between low and intermediate-high risk groups

Tsung-Yu Ko1,2, , Hsien-Li Kao1, , Chih-Fan Yeh1, , Jiu-Hsiang Lin3, , Ching-Chang Huang1, , Ying-Hsien Chen1, , Chi-Chao Chao4, , Hung-Yuan Li1, , Chih-Yang Chan5, , Lung-Chun Lin1, , Yih-Sharng Chen5, , Ming-Jiuh Wang6, , Mao-Shin Lin1, ,

  • 1 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
  • 2 Graduate Institute of Clinical Medicine, Medical College, National Taiwan University, Taipei, Taiwan
  • 3 Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
  • 4 Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
  • 5 Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
  • 6 Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan

Received: May 5, 2022       Accepted: July 3, 2022       Published: August 5, 2022      

https://doi.org/10.18632/aging.204202
How to Cite

Copyright: © 2022 Ko et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Background: Data comparing the neurocognitive trajectory between low and intermediate-high risk patients following transcatheter aortic valve replacement (TAVR) is never reported.

Aims: To report serial neurocognitive changes up to 1 year post-TAVR in low and intermediate-high risk groups as well as overall cohort.

Methods: Prospective neurological assessments (NIHSS and Barthel Index), global cognitive tests (MMSE and Alzheimer Disease Assessment Scale–Cognitive Subtest, ADAS-cog) and executive performances (Color Trail Test A and B and verbal fluency), were applied at baseline, 3 months and 1 year post-TAVR.

Results: In overall cohort, persistent improvement to 1 year in MMSE, ADAS-cog, Color Trail Test A and B was found. According to the STS score, the study cohort was divided into low (<4%, N = 81) and intermediate-high (≧4%, N = 75) risk groups. The baseline neurologic and cognitive performance was significantly worse in intermediate-high risk group. Slight improvement on general neurological functions (Barthel index and proportion of NIHSS>0 patients) at 1 year could be observed only in intermediate-high risk group. In global cognitive assessments, improvement in MMSE and ADAS-cog at 1 year was found in both groups, but the proportion of cognitive improvement was more obvious in intermediate-high risk group. In Color Trail Tests and verbal fluency, significant and persistent improvement up to 1 year could be observed only in low risk group.

Conclusions: TAVR was associated with persistent improvement in global cognitive function, as well as in attention and psychomotor processing speed, up to 1 year in overall cohort. However, improvement in tests for executive functions can only be seen in low risk group.

Abbreviations

ADAS-cog: Alzheimer’s Disease Assessment Scale cognitive subscale; DWI: Diffusion weighted magnetic resonance imaging; MMSE: Mini-Mental State Examination; NIHSS: National Institutes of Health Stroke Scale; STS-PROM: Society of Thoracic Surgeons Predicted Risk of Mortality score; TAVR: Transcatheter aortic valve replacement; VARC: Valve Academic Research Consortium.