David Z. Rose (United States of America)
University of South Florida
Neurology
David Z. Rose, M.D. is Associate Professor of Vascular Neurology at the University of South Florida (USF), and co-director of the 32-bed Neuro-ICU at Tampa General Hospital. Dr. Rose graduated from Stroke Fellowship at the University of Pennsylvania in Philadelphia, from Neurology Residency at the University of Miami’s Jackson Memorial Hospital, and from Internal Medicine Residency at the Cleveland Clinic in Ohio. Research interests include early use of Direct Oral Anticoagulants (DOAC) in Stroke with Atrial Fibrillation (AF), incidence of dementia in AF clinics and alternate options to anticoagulation such as Left Atrial Appendage Closure/Occlusion, Hypertension management for Intracerebral Hemorrhage, Synthetic Cannabis “Spice” associated with neurologic syndromes, and stroke simulation education with neuro-mnemonics. In 2014, he co-authored a fun review book "Laughing Your Way to Passing the Neurology Boards."

Presenter of 1 Presentation

 Conference Calendar

INCIDENCE OF DEMENTIA IN ATRIAL FIBRILLATION CLINIC: A PROSPECTIVE ASSESSMENT

Session Name
0510 - VCI and Dementia (ID 38)
Session Type
Free Communication Session
Date
28.10.2021, Thursday
Session Time
17:45 - 19:15
Room
FREE COMMUNICATIONS A
Presenter
Lecture Time
18:05 - 18:15

Abstract

Background and Aims

In atrial fibrillation (AF), anticoagulation helps prevent ischemic stroke but poses higher risk of intracranial hemorrhage (ICH) in the elderly and those with dementia. Cerebral Amyloid Angiopathy (CAA) is a subtype of dementia with a brain MRI revealing cerebral micro-bleeds (CMB) that may convert into ICH. Outcomes are poor for ICH patients on anticoagulation, which complicates AF treatment decision-making in the elderly.

Methods

In an interdepartmental collaboration, the University of South Florida Neuro-Cardiac Program designed the DAME-Detect (Dementia in Atrial fibrillation with Micro-bleeds Early Detection) prospective observational study. University of South Florida cardiology clinics were pre-screened based on AF status and age>65. Qualified subjects were screened with a validated test called “Symptoms of Early Dementia-11 Questionnaire” (SED-11Q).

Results

Pre-screening of 2,682 patients in 7 cardiology clinics identified 323 eligible subjects over 65 years old with confirmed AF. From this population, 100 agreed to consent, were enrolled into DAME-Detect, and received the Q11-SED. Of these, 19% screened positive by scoring 4 or higher on the Q11-SED.

Conclusions

About 1 in 5 elderly patients with AF in the outpatient cardiology office may have dementia, and hence represent high risk of ICH on anticoagulation. Thus, dementia screening of this vulnerable population may be warranted. Ongoing data review of DAME-Detect will examine referral requests, MRI-confirmed incidence of CMB/CAA, and anticoagulation patterns. A larger, future study may identify pathways to mitigate ICH risk with non-pharmacologic alternatives to stroke prevention in elderly patients with AF and dementia.

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