Background In elderly patients undergoing transcatheter aortic valve replacement (TAVR), preserving cognitive function and early detection of cognitive decline are important for maintaining quality of life after the procedure. While studies have reported cognitive changes after TAVR via short-form tests, research on the role of full neuropsychological test batteries remains limited. Objectives To investigate short-term changes in cognitive function via a full neuropsychological test battery. Methods In this observational cohort study, 70 patients who underwent elective TAVR were assessed for cognitive performance via the Seoul Neuropsychological Screening Battery (SNSB) at baseline and 3 months post-TAVR. Mild cognitive impairment (MCI) was defined as a deterioration greater than 1.5 standard deviations below the normative mean. We also evaluated the effectiveness of the Mini-Mental State Examination (MMSE) in detecting MCI as assessed by the SNSB. Results The total SNSB z score significantly improved from baseline to 3 months post-TAVR (-0.73 [-1.58, -0.1] to -0.61 [-1.31, 0.1], P = 0.003), with notable enhancements in language, memory, and frontal/executive function. The incidence of MCI was 47.1% preoperatively and 45% at 3 months. Receiver operating characteristic curve (AUC) analysis revealed that the MMSE had good to excellent diagnostic ability for both multiple-domain and amnestic MCI compared to no MCI (AUC of 0.907 [95% CI, 0.790–0.971] and AUC of 0.796 [0.665–0.894], respectively) but it was ineffective in detecting single-domain MCI (AUC of 0.626 [0.486–0.751]). Conclusion We found that patients who underwent TAVR had overall improvements in cognitive function at short-term follow-up. Our study highlights domain-specific cognitive changes and confirms the effectiveness of the MMSE in screening for clinically relevant cognitive impairment in elderly patients undergoing TAVR. Clinical trial registration This study was registered with the Clinical Research Information Service (<a href="https://cris.nih.go.kr/cris/search/detailSearch.do?search_lang=E%26;focus=reset_12%26;search_page=M%26;pageSize=10%26;page=undefined%26;seq=20661%26;status=5%26;seq_group=18840">https://cris.nih.go.kr/cris/search/detailSearch.do?search_lang=E&focus=reset_12&search_page=M&pageSize=10&page=undefined&seq=20661&status=5&seq_group=18840</a> and identifier: KCT0005970, principal investigator: Jeong-Jin Min, Date of registration: March 8, 2021).

Evaluation of neurocognitive function changes based on the full neuropsychological test battery after transcatheter aortic valve replacement under monitored anaesthesia care

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2025年7月8日

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Eun Jung Oh,
Jong-Hwan Lee,
Yisuh Ahn,
Sung-Ji Park,
Eun Kyung Kim,
Seung-Hyuk Choi,
Jin Hee Ahn,
Jeong-Jin Min

摘要

Background

In elderly patients undergoing transcatheter aortic valve replacement (TAVR), preserving cognitive function and early detection of cognitive decline are important for maintaining quality of life after the procedure. While studies have reported cognitive changes after TAVR via short-form tests, research on the role of full neuropsychological test batteries remains limited.

Objectives

To investigate short-term changes in cognitive function via a full neuropsychological test battery.

Methods

In this observational cohort study, 70 patients who underwent elective TAVR were assessed for cognitive performance via the Seoul Neuropsychological Screening Battery (SNSB) at baseline and 3 months post-TAVR. Mild cognitive impairment (MCI) was defined as a deterioration greater than 1.5 standard deviations below the normative mean. We also evaluated the effectiveness of the Mini-Mental State Examination (MMSE) in detecting MCI as assessed by the SNSB.

Results

The total SNSB z score significantly improved from baseline to 3 months post-TAVR (-0.73 [-1.58, -0.1] to -0.61 [-1.31, 0.1], P = 0.003), with notable enhancements in language, memory, and frontal/executive function. The incidence of MCI was 47.1% preoperatively and 45% at 3 months. Receiver operating characteristic curve (AUC) analysis revealed that the MMSE had good to excellent diagnostic ability for both multiple-domain and amnestic MCI compared to no MCI (AUC of 0.907 [95% CI, 0.790–0.971] and AUC of 0.796 [0.665–0.894], respectively) but it was ineffective in detecting single-domain MCI (AUC of 0.626 [0.486–0.751]).

Conclusion

We found that patients who underwent TAVR had overall improvements in cognitive function at short-term follow-up. Our study highlights domain-specific cognitive changes and confirms the effectiveness of the MMSE in screening for clinically relevant cognitive impairment in elderly patients undergoing TAVR.

Clinical trial registration

This study was registered with the Clinical Research Information Service (https://cris.nih.go.kr/cris/search/detailSearch.do?search_lang=E&focus=reset_12&search_page=M&pageSize=10&page=undefined&seq=20661&status=5&seq_group=18840 and identifier: KCT0005970, principal investigator: Jeong-Jin Min, Date of registration: March 8, 2021).