App-based assessment of neurocognitive changes in patients undergoing transcatheter aortic valve implantation - a prospective cohort study

Transcatheter aortic valve implantation (TAVI) has emerged as an established treatment for severe aortic stenosis in elderly patients. Periprocedural cerebral embolic events are common and may contribute to subtle neurocognitive changes. Conventional neurocognitive assessments are time-consuming and resource-intensive, limiting their routine use. Digitalized, app-based testing with AI-assisted recording may offer a feasible alternative. This study aimed to evaluate the use of app-based cognitive screening with AI-assisted recording in elderly TAVI patients and, building on prior pilot findings, to provide a more comprehensive, norm-referenced evaluation of cognitive function across multiple domains.

Neurocognitive assessments were performed before and after TAVI. Seven validated tests were administered and recorded using the “Δelta-App” on a tablet. Patient performance was compared with normative data.

Between October 2020 and March 2022, 141 patients (mean age 81 ± 6 years; 57.5% male) were enrolled, of whom 112 (79%) completed post-TAVI testing. Memory performance improved significantly (Word List Learning + 2.13 (± 3.22) words; P < 0.001; Word List Recall + 1 word; P < 0.001), while executive function, attention and processing speed remained stable. Overall, 37.7% were cognitively impaired pre-TAVI vs. 31.6% post-TAVI, with 59.6% remaining stable. Compared with normative data, performance was reduced but unchanged post-procedure. The app-based assessment proved well applicable in this elderly population.

In this single-center study, TAVI was not associated with a consistent decline in global cognitive performance during the early postoperative period. App-based neurocognitive testing proved to be readily applicable and may represent a valuable tool for routine clinical monitoring, supporting systematic assessment and early detection of cognitive changes to optimize rehabilitation outcomes.