Jaclyn Reckow

Date of Award

January 2016

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Psychology

First Advisor

Thomas V. Petros

Second Advisor

F. Richard Ferraro

Abstract

Aortic stenosis is a cardiovascular disease affecting 2 to 4% of U.S. adults over

age 65 years old (Freeman & Otto, 2006). Aortic stenosis causes angina and syncope

eventually leading to heart failure and death (Otto, 2006). Transcatheter aortic valve

implantation (TAVI) is an alternative to surgical aortic valve replacement in patients with

high surgical mortality risk (Kappetein, 2013). The TAVI is associated with increased

cerebral injury, with silent ischemia reported in up to 90% of TAVI patients (Samim et

al., 2015). The present study examines the relationship between cerebral injury, cognitive

changes, and quality of life in TAVI patients.

Participants (n = 40) completed a cognitive assessment one day before the TAVI

and at one-month post-TAVI. The primary cognitive measure was the Repeatable Battery

for the Assessment of Neuropsychological Status (RBANS). Additional tests (letter

fluency, Trail Making Test, Digit Span Backward and Stroop) were included as measures

of executive function and working memory. Measures of functional ability (Physical

Self-Maintenance Questionnaire, Functional Activities Questionnaire, Dementia Severity

Rating Scale), mood (GDS), and quality of life (Kansas City Cardiomyopathy

Questionnaire) were also included. Baseline and follow-up MRIs were completed for 22

participants. Baseline RBANS Total Index scores (M = 85.26, SD = 14.69) evidenced

mild cognitive decline prior to the TAVI. At one month, there was significant

improvement on RBANS Language Index (p = 0.014), RBANS Fluency (p = 0.023),

RBANS Figure Recall (p = 0.027), GDS (p = 0.018), and KCCQ (p < 0.001). There was a significant decline on RBANS List Recall (p = 0.001). Six participants (27%) obtained

new cerebral lesions at one month. Participants with neuronal injury did not differ from

those without at one month (RBANS Total Score, p = 0.45).

TAVI is related to overall stable cognitive performance and improved quality of

life. The relationship between cerebral ischemia following TAVI and negative cognitive

consequences is not supported. Further research is required in the cognitive implications

following TAVI.

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