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Silent Brain Infarcts Impact on Cognitive Function in Atrial Fibrillation
Quick Takes
- There is an established association between atrial fibrillation and development of cognitive decline in stroke-free individuals, and this association may be driven by silent brain infarcts.
- In this study, patients with incident silent or symptomatic brain infarcts on MRI performed worse on a battery of cognitive tests at 2-year follow-up than those without incident infarct. Anticoagulation was not clearly protective.
Study Questions:
What is the association between incident symptomatic and clinically silent brain infarcts and cognitive change in patients with atrial fibrillation (AF)?
Methods:
This is a substudy of the Swiss-AF study, which is a prospective cohort study of individuals (mostly ≥65 years) with AF. A total of 1,227 patients met substudy criteria and were included in this analysis. At baseline and during yearly in-person study visits, subjects were surveilled for clinical stroke. Subjects underwent magnetic resonance brain imaging at baseline and at the 2-year follow-up visit. Cognitive testing was performed annually using three cognitive tests.
Results:
After 2 years of follow-up, 2.3% of patients had a clinical stroke or transient ischemic attack and 5.5% of patients had ≥1 new lesion detected on their 2-year follow-up magnetic resonance imaging (MRI). 85% of infarcts were clinically silent; 90% of patients with symptomatic infarcts and 88% of patients with silent infarcts were anticoagulated at baseline. Patients with incident silent or symptomatic brain infarcts performed worse (showed more deterioration) on the battery of cognitive tests at 2-year follow-up than those without.
Conclusions:
Symptomatic and silent ischemic brain infarcts may be important mediators of cognitive decline in patients with AF. Anticoagulation may be insufficient to prevent the progression of cognitive decline caused by brain injury in these patients.
Perspective:
There is an established association between AF and the development of cognitive decline in stroke-free individuals, and this association may be driven by silent cerebral infarcts. In this prospective cohort study, patients with incident silent or symptomatic brain infarcts performed worse on a battery of cognitive tests at 2-year follow-up than those without incident infarct. Anticoagulation was not clearly protective. Future studies may wish to investigate the association of rhythm control or left atrial appendage occlusion with incident silent brain infarcts and cognitive decline.
Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Noninvasive Imaging, Prevention, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Magnetic Resonance Imaging
Keywords: Anticoagulants, Arrhythmias, Cardiac, Atrial Appendage, Atrial Fibrillation, Brain Infarction, Brain Injuries, Cerebral Infarction, Cognition, Ischemic Attack, Transient, Cognitive Dysfunction, Magnetic Resonance Imaging, Neuroimaging, Secondary Prevention, Stroke, Vascular Diseases
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