Association Between Motor and Cognitive Performances in Elderly With Atrial Fibrillation: Strat-AF Study.

Emilia Salvadori,Francesco Galmozzi,Rossella Marcucci,Anna Maria Gori,Valentina Rinnoci,Cristina Sarti,Chiara Marzi,Anna Melone,Anna Poggesi,Benedetta Formelli,Giovanni Pracucci,Carmen Barbato,Stefano Diciotti,Francesca Uda,Eleonora Camilleri,Samira Donnini,Stefano Chiti,Silvia Galora,Betti Giusti,Francesca Pescini,Damiano Mistri,Enrico Fainardi,Francesca Cesari

doi:10.3389/fneur.2020.571978

Abstract

Background/Objective: Growing evidence suggests a close relationship between motor and cognitive abilities, but possible common underlying mechanisms are not well-established. Atrial fibrillation (AF) is associated with reduced physical performance and increased risk of cognitive decline. The study aimed to assess in a cohort of elderly AF patients: (1) the association between motor and cognitive performances, and (2) the influence and potential mediating role of cerebral lesions burden.Design: Strat-AF is a prospective, observational study investigating biological markers for cerebral bleeding risk stratification in AF patients on oral anticoagulants. Baseline cross-sectional data are presented here.Setting: Thrombosis outpatient clinic (Careggi University Hospital).Participants: One-hundred and seventy patients (mean age 77.7 ± 6.8; females 35%).Measurements: Baseline protocol included: neuropsychological battery, motor assessment [Short Physical Performance Battery (SPPB), and walking speed], and brain magnetic resonance imaging (MRI) used for the visual assessment of white matter hyperintensities, lacunar and non-lacunar infarcts, cerebral microbleeds, and global cortical and medial temporal atrophies.Results: Mean Montreal Cognitive Assessment (MoCA) total score was 21.9 ± 3.9, SPPB total score 9.5 ± 2.2, and walking speed 0.9 ± 0.2. In univariate analyses, both SPPB and walking speed were significantly associated with MoCA (r = 0.359, r = 0.372, respectively), visual search (r = 0.361, r = 0.322), Stroop (r = −0.272, r = −0.263), short story (r = 0.263, r = 0.310), and semantic fluency (r = 0.311, r = 0.360). In multivariate models adjusted for demographics, heart failure, physical activity, and either stroke history (Model 1) or neuroimaging markers (Model 2), both SPPB and walking speed were confirmed significantly associated with MoCA (Model 1: β = 0.256, β = 0.236; Model 2: β = 0.276, β = 0.272, respectively), visual search (Model 1: β = 0.350, β = 0.313; Model 2: β = 0.344, β = 0.307), semantic fluency (Model 1: β = 0.223, β = 0.261), and short story (Model 2: β = 0.245, β = 0.273).Conclusions: In our cohort of elderly AF patients, a direct association between motor and cognitive functions consistently recurred using different evaluation of the performances, without an evident mediating role of cerebral lesions burden.

Highlights

Gait is a complex task involving the integration of several brain regions, and high-order cognitive functions are currently recognized to play a role in coordinating and controlling mobility [1, 2]
The present study aims to assess in a cohort of elderly patients with a diagnosis of Atrial fibrillation (AF) and ongoing anticoagulant therapy: [1] the association between motor and cognitive performances, and [2] the influence and potential mediating role of cerebral lesions burden
From September 2017 to March 2019, out of the 194 subjects enrolled in the Strat-AF study, 170

Summary

Introduction

Gait is a complex task involving the integration of several brain regions, and high-order cognitive functions are currently recognized to play a role in coordinating and controlling mobility [1, 2]. Aging is known to be related to both cognitive decline and reduced physical performance These processes may occur separately, a growing body of literature suggests the presence of a close relationship between cognitive and motor dysfunction. Executive functions and processing speed are the most commonly associated with gait dysfunction, with evidence coming both from studies on healthy older adults and on neurologic patients [9, 10]. Both neurodegenerative and vascular processes are well-known neurobiological determinants of cognitive decline and could to some extent contribute to motor impairment. Since gait disturbances may differ among the various mechanisms related to the cerebral lesion burden, the interplay between cognitive and motor dysfunctions and the determination of different profiles of gait disturbance among the various subtypes of preclinical or clinical dementia may further contribute to early and differential diagnoses [11,12,13,14]

Methods

Results

Conclusion