scholarly journals Cognitive Impairment Is Not a Predictor of Failure to Adhere to Anticoagulation of Stroke Patients with Atrial Fibrillation

2015 ◽  
Vol 39 (5-6) ◽  
pp. 325-331 ◽  
Author(s):  
Solveig Horstmann ◽  
Timolaos Rizos ◽  
Michaela Saribas ◽  
Evdokia Efthymiou ◽  
Geraldine Rauch ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Cognitive Impairment ◽  
Functional Status ◽  
Cognitive Performance ◽  
Functional Disability ◽  
Cognitive Status ◽  
Stroke Severity ◽  
Detailed Medical History

Background: Oral anticoagulation (OAC) with vitamin K antagonists (VKA) or direct oral anticoagulants (DOAC) is an effective strategy that is used for stroke prevention in patients with atrial fibrillation (AF). However, OAC is underused particularly in elderly patients, who are often physically disabled or cognitively impaired. We aimed at evaluating the effect of cognitive status and disability on OAC adherence 1 year after stroke or TIA. Methods: In this prospective, single-center, observational study patients with ischemic stroke or TIA were consecutively included between 3/2011 and 9/2012. The detailed medical history, basic demographic variables, cardiovascular risk factors, stroke severity according to the National Institutes of Health Stroke Scale (NIHSS), medication including OAC were all recorded. Cognitive performance was measured using the Montreal Cognitive Assessment (MoCA) score at baseline. The functional status was assessed by recording activities and instrumental activities of daily living, respectively (ADL, IADL). After 12 months, patients had a follow-up visit to reassess the cognitive and functional status (MoCA, ADL and IADL) and to document the current use of OAC. Results: In total, 12 months after the ischemic stroke or TIA AF had been diagnosed in 160/586 (27.3%). Of these, 151 patients (94.4%) were treated with OAC. OAC was performed using VKA in 79/151 (52.3%) and DOACs in 72/151 (47.7%). Cognitive impairment at 12 months follow-up was not associated with the absence of OAC treatment. However, regression analysis revealed that patients with AF with physical (ADL) and functional disability (IADL) were less likely to be treated with OAC (p = 0.08 and p = 0.04, respectively) 12 months after a stroke. None of these two factors, however, was independently associated with nonadherence to OAC 12 months after stroke. Although cognitive performance was similar in patients receiving VKA and direct anticoagulants (DOAC), adherence to VKA tended to be lower (82.6 vs. 94.6%, p = 0.12). Conclusions: In stroke and TIA patients with AF, the multifactorial medical and functional constellation rather than cognitive impairment specifically can be an obstacle for long-term OAC.

scholarly journals Study on outcome of ischemic stroke patient with atrial fibrillation

KYAMC Journal ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. 8-12
Author(s):  
Achinta Kumar Mallick ◽  
Md Ahmed Ali ◽  
Md Kafiluddin ◽  
Md Parvez Amin ◽  
Pijus Kumar Kundu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Case Fatality ◽  
The Elderly ◽  
Clinical Deterioration ◽  
Stroke Recurrence ◽  
Stroke Severity ◽  
Ischemic Stroke Patient ◽  
Fold Excess

Background: Atrial fibrillation (AF) is a common arrhythmia and a major risk factor for ischemic stroke, especially in the elderly patients. Patients with non-valvular AF have a 5-fold excess risk of stroke recurrence and case-fatality rate.Objectives: This study was to evaluate the prevalence of AF and its influence on prognosis in patients with ischemic stroke.Materials & Methods: Total 125 patients with ischaemic stroke were enrolled in this study. Initially they were divided into two groups by ECG - those with AF and those without AF. They were followed up after one month, three months and six months. Comparison was done between the two groups in term of recurrence, mortality and clinical improvement which were assessed by Modified Rankin Score (MRS).Results: Among 125 patients, 22 patients had AF. Those with AF were more frequently male, aged more than 45 years. Recurrence was significantly higher in AF group during one month follow up (p<0.05). The presence of AF was associated with higher mortality in 3 months (p<0.05) and 6 months (p<0.05) follow up. At 3 months follow up clinical deterioration was noted in 9.1% patient with AF compared to 2.9% patients without AF (p<0.01) and at 6 months follow up clinical deterioration was noted in 18.2% patient with AF compared to 4.9% patients without AF (p<0.01).Conclusion: Patients who had an ischemic stroke with accompanying AF had higher mortality, graver stroke severity, more recurrences and poorer functional status than those without AF.KYAMC Journal Vol. 8, No.-2, Jan 2018, Page 8-12

scholarly journals Study of Outcome of Ischemic Stroke Patient With Atrial Fibrillation

2018 ◽  
Vol 28 (2) ◽  
pp. 1-6
Author(s):  
Achinta Kumar Mallick ◽  
Md Kafil Uddin ◽  
Md Ahmed Ali ◽  
Pijus Kumar Kundu ◽  
Sheikh Mohammad Emdadul Haque ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Ischemic Stroke ◽  
Linear Regression Analysis ◽  
Clinical Deterioration ◽  
Stroke Recurrence ◽  
Stroke Severity ◽  
Multivariate Linear Regression Analysis ◽  
Stroke Patients

Atrial fibrillation (AF) is a common arrhythmia and a major risk factor for ischemic stroke, especially in the elderly. Patients with nonvalvular AF have a 5-fold excess risk of stroke. However, population-based data are scarce in patients who have experienced a first-ever ischemic stroke in the presence of AF regarding long-term risk of stroke recurrence and case-fatality rate. Aim of the study is to find out the outcome of ischemic stroke patients with Atrial Fibrillation. It was a descriptive type cross sectional study where 125 diagnosed cases of ischemic stroke were included. Presence of atrial fibrillation was detected by electrocardiogram. They were divided into two groups – those with atrial fibrillation and those without. Comparison was done between the two group in term of recurrence, mortality and clinical improvement. Atrial fibrillation was present in 22 (17.6%) of 125 patients with ischemic stroke. Those with AF were more frequently male, aged 45 years and older. The presence of AF was associated with high 3 months (Χ2 =4.562, df = 1, p<0.05) and 6 months mortality (Χ2 =7.868, df = 1, p<0.05), with a higher stroke recurrence rate within the first 6 months follow-up (22.7% versus 7.8% (<0.05)). At 3 months follow up clinical deterioration was noted in 9.1% patient with atrial fibrillation compared to 2.9% patients who had no arrhythmia(p<0.01) and at 6 months follow up clinical deterioration was noted in 18.2% patient with atrial fibrillation compared to 4.9% patients who had no arrhythmia(p<0.01). Ischemic stroke patients with atrial fibrillation had significant mortality within the study period compared to those without atrial fibrillation. Significant deterioration in clinical outcome was noted in atrial fibrillation group after six months. Recurrence was more in ischemic stroke patients with atrial fibrillation. Multivariate linear regression analysis shows atrial fibrillation as well as CKD, Diabetes mellitus and smoking as independent risk factor for recurrence. In conclusion, patients who had an ischemic stroke with accompanying atrial fibrillation had higher mortality, grave stroke severity, more recurrences and poorer functional status than those without atrial fibrillation.TAJ 2015; 28(2): 1-6

Abstract P56: Diffusion Tensor Imaging at the Time of Stroke is Associated With Cognitive Performance 4 Months Later

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Kyle C Kern ◽  
Clinton B Wright ◽  
Richard Leigh
Keyword(s):  
Cognitive Impairment ◽  
Diffusion Tensor Imaging ◽  
White Matter ◽  
Linear Regression ◽  
Cognitive Performance ◽  
Diffusion Tensor ◽  
Cognitive Status ◽  
Cognitive Testing ◽  
Brain Health

Introduction: Cognitive impairment after stroke is associated with stroke severity and baseline brain health. We hypothesized that acute diffusion tensor imaging (DTI) metrics would identify patients at risk for post-stroke cognitive impairment. Methods: Patients were enrolled prospectively in an observational study that involves serial MRI and cognitive testing in patients with recent stroke and moderate white matter disease on MRI but without dementia. DTI was performed at the time of stroke; cognitive testing with the MOCA and the Telephone Interview for Cognitive Status (TICS) were performed 3 months later. DTI was used to calculate Peak Skeletonized Mean Diffusivity (PSMD), a measure of global white matter microstructural integrity previously validated in cerebral small vessel disease. Fractional anisotropy maps were skeletonized (figure panel A) and a histogram of the corresponding MD values was used to calculate the peak width in the non-stroke hemisphere (panel B). Linear regression was used to test whether acute PSMD in the non-stroke hemisphere, acute stroke volume, or baseline NIHSS predicted cognitive performance 3 months later. Results: Fourteen patients followed-up at a median of 123 days. Patients had a median age of 73 years, mean baseline NIHSS of 1.2 (IQR 0-1.75), mean infarct volume of 4cc (range 0-16cc), mean MOCA of 25 (range 19-30), mean TICS of 33 (range 23-41), and 50% were women. Using multivariable linear regression, only acute PSMD predicted follow-up MOCA (std beta= -0.64, adj R 2 = 0.37, p= 0.013) while compared to baseline NIHSS, PSMD showed a stronger association with follow-up TICS score (std beta= -0.57 vs -0.44, p= 0.017; model adj R 2 = 0.476, p= 0.011)(Panel C). Conclusions: In this cohort of patients with small strokes we found that acute contralateral PSMD provided a measure of brain health that appears to predict cognitive performance at 3 months better than stroke size or severity. These are preliminary findings from an ongoing study.

Abstract W MP106: Clinical Effectiveness of Anticoagulation with Warfarin among Ischemic Stroke Patients with Atrial Fibrillation: Findings from the Patient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) Study

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Ying Xian ◽  
Jingjing Wu ◽  
Emily C O’Brien ◽  
Gregg C Fonarow ◽  
DaiWai M Olson ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Warfarin Therapy ◽  
Stroke Severity ◽  
Stroke Survivors ◽  
Stroke Patients ◽  
Long Term Outcomes ◽  
Warfarin Treatment

Background: Oral anticoagulation is recommended for ischemic stroke patients with atrial fibrillation, based on clinical trials done in selected populations. However, little is known about whether the clinical benefit of warfarin is preserved outside the clinical trial setting, especially in older patients with ischemic stroke. Methods: PROSPER, a PCORI-funded research program designed by stroke survivors and stakeholders, used American Heart Association Get With The Guidelines (GWTG)-Stroke data linked to Medicare claims to evaluate the association between warfarin treatment at discharge and long-term outcomes among ischemic stroke survivors with atrial fibrillation (AF) and no contraindication to or prior anticoagulation therapy. The primary outcome prioritized by patients was home-time (defined as days spent alive and not in inpatient post-acute care facility) within 2-year follow-up after discharge. Results: Of 12,552 ischemic stroke patients with AF admitted from 2009-2011, 11,039 (88%) received warfarin treatment at discharge. Compared with those not receiving any anticoagulation, warfarin-treated patients were slightly younger (mean 80 vs. 83, p<0.001), less likely to have a history of prior stroke or coronary artery disease, but had similar stroke severity as measured by NIHSS (median 5 [IQR 2-12] vs. 6 [2-13], p=0.09). After adjustment for all observed baseline characteristics using propensity score inverse probability weighting method, patients discharged on warfarin therapy had 45 more days of home-time during 2-year follow-up than those not receiving any oral anticoagulant (513 vs. 468 days, p<0.001). Warfarin use was also associated with a lower risk of all-cause mortality, cardiovascular readmission or death, and ischemic stroke (Table). Conclusions: Among ischemic stroke patients with atrial fibrillation, warfarin therapy was associated with improved long-term outcomes.

Abstract TP429: Early Oral Anticoagulation After Acute Ischemic Stroke in Patients With Atrial Fibrillation

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Andrew B Buletko ◽  
Rejo P Cherian ◽  
Christine Ahrens ◽  
Ken Uchino ◽  
Andrew Russman
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Oral Anticoagulation ◽  
Infarct Volume ◽  
Cleveland Clinic ◽  
Early Initiation ◽  
Stroke Severity ◽  
Major Hemorrhage

Introduction: Uncertainty exists as to the optimum interval for initiation of oral anticoagulation (OAC) after an acute ischemic stroke (AIS) in patients with atrial fibrillation (AF). Randomized clinical trials of novel oral anticoagulants excluded patients with AIS within 7-14 days. We sought to identify patients at low risk for early initiation of OAC after AIS. Hypothesis: The benefit of starting OAC within 2 days to prevent recurrent AIS outweighs the risk of hemorrhagic transformation (HT) in select patients. Methods: Following IRB approval, we completed a retrospective review of patients from the Cleveland Clinic from 2012-2014 with AIS, AF, and at least 1 follow up visit. In addition to demographic and medical history, acute infarct volume on imaging, presence of HT on imaging prior to OAC, timing and type of oral anticoagulation, and ischemic and hemorrhagic complications were noted. Early OAC was defined as starting within 48 hours after stroke onset, and late OAC was thereafter. The two groups were compared using Fisher’s exact test for categorical and Wilcoxon Rank Sum for numeric variables. Results: One hundred patients (median age 76, interquartile range 66-84) met our study criteria. Thirty-one patients were started on OAC within 2 days vs 53 patients after 2 days (median 1 days vs median 11 days). Compared to patients started on OAC after 2 days, those who initiated OAC within 2 days had significantly lower infarct volume (median 3.35 ml vs median 9.8 ml; p<0.0001), initial NIHSS (median 3 vs median 7; p <0.0001), and fewer people with blood on brain imaging (3% vs 26%; p= 0.0074). Age, prior stroke, and choice of OAC were not significantly associated with timing of OAC. No patients had recurrent AIS or symptomatic HT at median follow-up observation of 37 days. One patient had a non-CNS major hemorrhage after starting OAC. Sixteen patients were not started on OAC for a variety of reasons. Conclusions: Our results suggest the safety of early initiation of OAC with 2 days in an appropriately selected population of patients with AIS, who have small infarct volumes, mild stroke severity, and lack of HT.

scholarly journals Predicting Cognitive Decline and Dementia with the Newly Normed SKT Short Cognitive Performance Test

2019 ◽  
Vol 9 (1) ◽  
pp. 184-193 ◽  
Author(s):  
Mark Stemmler ◽  
Johannes Baltasar Hessler ◽  
Horst Bickel
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Performance ◽  
Performance Test ◽  
Rating Scale ◽  
Cognitive Status ◽  
Traffic Light ◽  
Clinical Dementia Rating ◽  
Kaplan Meier ◽  
Dementia Onset

Objective: The aim of this article was to determine the criterion-related validity of the newly normed SKT (Syndrom-Kurztest) Short Cognitive Performance Test with the onset of dementia as the predicted criterion. Methods: The cognitive ability was tested with the SKT in a sample of 546 cognitively healthy adults aged 65–85 years. New cases of mild cognitive impairment (MCI) or dementia were determined in 3 follow-up investigations at 1-year intervals. Each participant’s cognitive status was rated on the Clinical Dementia Rating Scale. The cognitive status according to the SKT is presented in terms of a traffic light system. Results: Based on Kaplan-Meier estimators, the trajectories of the different SKT traffic light labels were investigated over 3 years. The trajectories were significantly different, representing differential risks for dementia onset. In comparison to the green group, the hazard ratio (HR) for the development of dementia and MCI amounted to HR 6.63 (95% CI 2.75–15.96) and HR 2.34 (95% CI 1.37–3.99), respectively, in the yellow group, and to HR 25.40 (95% CI 10.73–60.14) and HR 3.83 (95% CI 1.86–7.86), respectively, in the red group. Conclusions: The newly normed SKT showed a high predictive validity for the onset of dementia.

scholarly journals Atrial Fibrillation Predicts Cognitive Impairment in Patients With Ischemic Stroke

2011 ◽  
Vol 26 (8) ◽  
pp. 623-626 ◽  
Author(s):  
Eliyahu Hayim Mizrahi ◽  
Anna Waitzman ◽  
Marina Arad ◽  
Abraham Adunsky
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Cognitive Impairment ◽  
Chart Review ◽  
Multiple Logistic Regression Analysis ◽  
Retrospective Chart Review ◽  
Cognitive Status ◽  
Increased Risk ◽  
Review Study ◽  
State Examination

Background: Atrial fibrillation (AF) is considered as a risk factor for cognitive impairment. Methods: This retrospective chart review study was conducted in a patient stroke rehabilitation ward of a university-affiliated referral hospital. The participants were 707 patients admitted for a standard rehabilitation course after an ischemic stroke. Cognitive status was assessed by the Mini-Mental State Examination (MMSE), and scores lower than 24 points were considered as suggestive of cognitive impairment. Results: Atrial fibrillation, age, gender, diabetes, and dementia emerged as the only statistically significant parameters differing between those with MMSE score lower than 24 or higher. In a multiple logistic regression analysis, AF (odds ratio 1.6, 95% confidence interval 1.03-2.47, P = .03) was associated with an increased risk of cognitive impairment. Conclusions:Our findings suggest that atrial fibrillation upon admission is independently associated with lower MMSE scores in patients with ischemic stroke.

scholarly journals Assessment of cognitive impairment and related risk factors in hemodialysis patients

2021 ◽  
Author(s):  
Hristos Karakizlis ◽  
Katharina Bohl ◽  
Jannis Ziemek ◽  
Richard Dodel ◽  
Joachim Hoyer
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Cognitive Performance ◽  
Early Stage ◽  
Hemodialysis Patients ◽  
Cognitive Status ◽  
Cognitive Profile ◽  
Cognitive Test ◽  
Regional Government

Abstract Background Cognitive impairment in hemodialysis patients has been acknowledged over the last years and has been reported in up to 80% of patients. Older age, high prevalence of cardiovascular risk factors, such as stroke and transient ischemic attack, uremia, and multiple metabolic disturbances represent the most common factors for cognitive impairment in hemodialysis patients. Methods We conducted a prospective cohort study on 408 patients from 10 hemodialysis centers in the regional government district of Middle Hesse (Germany). Patients underwent a neuropsychological test battery consisting of five tests, in addition to a phonemic fluency test, to assess cognitive profile. The patients were classified into no cognitive impairment mildly-, moderately- or severely-impaired cognitive function, depending on the degree of impairment and number of domains where the deficit was determined. We analyzed the cognitive profile and the change in performance over time in hemodialysis patients based on their cognitive status at baseline vs. 1-year follow-up. Results Of 479 eligible patients, 408 completed all tests at baseline. Only 25% (n = 102) of the patients had no cognitive impairment. Fourteen per cent (n = 57), 36.5% (n = 149), and 24.5% (n = 100) of patients showed mild, moderate, and severe impairment, respectively. In patients with cognitive impairment, all cognitive domains were affected, and impairment was significantly associated with depression and education. The most impaired cognitive performance was immediate memory recall, and the best performance was found in naming ability. No significant  change was observed after 1 year- follow up in any domain. Conclusion Our study shows that the prevalence of cognitive impairment in hemodialysis patients is high and that it is affected by the presence of depression. Furthermore, education has an effect on cognitive test results. As depression has a significant influence on cognitive impairment, its early identification is essential in order to initiate treatment at an early stage, hoping to positively influence cognitive performance. Graphic abstract

scholarly journals The Number of Concomitant Drugs and the Safety of Direct Oral Anticoagulants in Routine Care Patients with Atrial Fibrillation

TH Open ◽  
2020 ◽  
Vol 04 (04) ◽  
pp. e417-e426
Author(s):  
Carline J. van den Dries ◽  
Sander van Doorn ◽  
Patrick Souverein ◽  
Romin Pajouheshnia ◽  
Karel G.M. Moons ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Major Bleeding ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Routine Care ◽  
P Value ◽  
Risk Of Mortality ◽  
Mortality Effect

Abstract Background The benefit of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) on major bleeding was less prominent among atrial fibrillation (AF) patients with polypharmacy in post-hoc randomized controlled trials analyses. Whether this phenomenon also exists in routine care is unknown. The aim of the study is to investigate whether the number of concomitant drugs prescribed modifies safety and effectiveness of DOACs compared with VKAs in AF patients treated in general practice. Study Design Adult, nonvalvular AF patients with a first DOAC or VKA prescription between January 2010 and July 2018 were included, using data from the United Kingdom Clinical Practice Research Datalink. Primary outcome was major bleeding, secondary outcomes included types of major bleeding, nonmajor bleeding, ischemic stroke, and all-cause mortality. Effect modification was assessed using Cox proportional hazard regression, stratified for the number of concomitant drugs into three strata (0–5, 6–8, ≥9 drugs), and by including the continuous variable in an interaction term with the exposure (DOAC vs. VKA). Results A total of 63,600 patients with 146,059 person-years of follow-up were analyzed (39,840 person-years of DOAC follow-up). The median age was 76 years in both groups, the median number of concomitant drugs prescribed was 7. Overall, the hazard of major bleeding was similar between VKA-users and DOAC-users (hazard ratio [HR] 0.98; 95% confidence interval [CI] 0.87–1.11), though for apixaban a reduction in major bleeding was observed (HR 0.81; 95% CI 0.68–0.98). Risk of stroke was comparable, while risk of nonmajor bleeding was lower in DOAC users compared with VKA users (HR 0.92; 95% CI 0.88–0.97). We did not observe any evidence for an impact of polypharmacy on the relative risk of major bleeding between VKA and DOAC across our predefined three strata of concomitant drug use (p-value for interaction = 0.65). For mortality, however, risk of mortality was highest among DOAC users, increasing with polypharmacy and independent of the type of DOAC prescribed (p-value for interaction <0.01). Conclusion In this large observational, population-wide study of AF patients, risk of bleeding, and ischemic stroke were comparable between DOACs and VKAs, irrespective of the number of concomitant drugs prescribed. In AF patients with increasing polypharmacy, our data appeared to suggest an unexplained yet increased risk of mortality in DOAC-treated patients, compared with VKA recipients.

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