Introduction Cognitive impairment is a common and disabling consequence of stroke. Its prevalence, the best way to screen for it in the acute setting, and its relation with premorbid status have not been thoroughly clarified. Materials and methods Ischemic and hemorrhagic stroke patients admitted to our stroke unit underwent a baseline assessment that included a clinical and neuroimaging assessment, two cognitive tests (clock‐drawing test, CDT; Montreal Cognitive Assessment‐Basic, MoCA‐B) and measures of premorbid function (including the Clinical Dementia Rating Scale). A follow‐up examination was repeated 3‐4 months after the acute event. Results Two hundred and twenty‐three patients (52.5% women, mean age ± SD 75.8 years ± 12.3) were evaluated. Prestroke cognitive impairment was present in 91 patients (40.8%). At follow‐up, the prevalence of cognitive impairment was 49%, while its incidence among patients who did not have any prestroke cognitive impairment was 38.8%. Of the originally admitted 223 patients (71 were lost to follow‐up), only 60 (26.9%) were still cognitively intact at follow‐up. On regression analysis, age and baseline CDT were associated with worsening of cognitive status at follow‐up. In patients without cognitive impairment at baseline, a cutoff of 23 for MoCA‐B and of 8.7 for CDT scores predicted the diagnosis of post‐stroke cognitive impairment with sufficient accuracy. Discussion and conclusion Prestroke and post‐stroke cognitive impairment affect a large proportion of patients with stroke. Our findings suggest that a neuropsychological screening during the acute phase might be predictive of the development of post‐stroke cognitive impairment.

PurposeMinimally invasive surgical ablation for atrial fibrillation (AF) has shown good results and low complications incidence. Our objective was to evaluate feasibility and efficacy of this technique in our center.MethodsThe procedure included pulmonary vein isolation, ganglionic plexi ablation, ligament of Marshall resection, and left atrial appendage exclusion through beating heart minimally invasive bilateral thoracotomies. Patients were monitored daily by telemedicine during the first 4 months and then by quarterly 24-h Holter monitoring or by implantable cardiac monitor. Ablation success was defined as freedom from any atrial tachyarrhythmia recurrence lasting more than 30 s and from antiarrhythmic drugs. All patients were followed up for a minimum of 12 months.ResultsTwenty-two consecutive patients with AF, paroxysmal in 27% and persistent in 73%, were treated. Mean age was 63 ± 10 years, 86% were men. Seventy-three percent of patients had previously undergone to one or more catheter ablations. Median follow-up period was 22 months (25°–75° percentile, 20–27). Patients free from any arrhythmia recurrence for at least 6 consecutive months discontinued antiarrhythmic therapy. Ablation was successful in 73% of patients at 12 months. Freedom from AF recurrences independently from antiarrhythmic therapy status was 91% at 12 months. Results were consistent in patients that reached 24 months follow-up. There were no deaths. Complications were: one conversion to sternotomy owing to thoracic adherences, one pacemaker implant, and one postoperative hemothorax requiring surgical revision.ConclusionsOur results show that minimally invasive surgical ablation was feasible and gave satisfactory results at long-term term follow-up in patients with AF.

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