Relationships of Overt and Silent Brain Lesions With Cognitive Function in Patients With Atrial Fibrillation.

Conen, David; Rodondi, Nicolas; Müller, Andreas; Beer, Juerg H; Ammann, Peter; Moschovitis, Giorgio; Auricchio, Angelo; Hayoz, Daniel; Kobza, Richard; Shah, Dipen; Novak, Jan; Schläpfer, Jürg; Di Valentino, Marcello; Aeschbacher, Stefanie; Blum, Steffen; Meyre, Pascal; Sticherling, Christian; Bonati, Leo H; Ehret, Georg; Moutzouri, Elisavet; ... (2019). Relationships of Overt and Silent Brain Lesions With Cognitive Function in Patients With Atrial Fibrillation. Journal of the American College of Cardiology, 73(9), pp. 989-999. Elsevier 10.1016/j.jacc.2018.12.039

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BACKGROUND Patients with atrial fibrillation (AF) have an increased risk of cognitive decline, potentially resulting from clinically unrecognized vascular brain lesions. OBJECTIVES This study sought to assess the relationships between cognitive function and vascular brain lesions in patients with AF. METHODS Patients with known AF were enrolled in a multicenter study in Switzerland. Brain magnetic resonance imaging (MRI) and cognitive testing using the Montreal Cognitive Assessment (MoCA) were performed in all participants. Large noncortical or cortical infarcts (LNCCIs), small noncortical infarcts (SNCIs), microbleeds, and white matter lesions were quantified by a central core laboratory. Clinically silent infarcts were defined as infarcts on brain MRI in patients without a clinical history of stroke or transient ischemic attack. RESULTS The study included 1,737 patients with a mean age of 73 ± 8 years (28% women, 90% taking oral anticoagulant agents). On MRI, LNCCIs were found in 387 patients (22%), SNCIs in 368 (21%), microbleeds in 372 (22%), and white matter lesions in 1715 (99%). Clinically silent infarcts among the 1,390 patients without a history of stroke or transient ischemic attack were found in 201 patients with LNCCIs (15%) and 245 patients with SNCIs (18%). The MoCA score was 24.7 ± 3.3 in patients with and 25.8 ± 2.9 in those without LNCCIs on brain MRI (p < 0.001). The difference in MoCA score remained similar when only clinically silent LNCCIs were considered (24.9 ± 3.1 vs. 25.8 ± 2.9; p < 0.001). In a multivariable regression model including all vascular brain lesion parameters, LNCCI volume was the strongest predictor of a reduced MoCA (β = -0.26; 95% confidence interval: -0.40 to -0.13; p < 0.001). CONCLUSIONS Patients with AF have a high burden of LNCCIs and other brain lesions on systematic brain MRI screening, and most of these lesions are clinically silent. LNCCIs were associated with worse cognitive function, even among patients with clinically silent infarcts. Our findings raise the question of MRI screening in patients with AF.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine

UniBE Contributor:

Rodondi, Nicolas; Moutzouri, Elisavet and Fischer, Urs

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0735-1097

Publisher:

Elsevier

Language:

English

Submitter:

Christine Baumgartner

Date Deposited:

12 Mar 2019 09:24

Last Modified:

24 Oct 2019 12:41

Publisher DOI:

10.1016/j.jacc.2018.12.039

PubMed ID:

30846109

Uncontrolled Keywords:

atrial fibrillation cognitive dysfunction microbleeds silent cerebral infarcts white matter lesions

BORIS DOI:

10.7892/boris.127791

URI:

https://boris.unibe.ch/id/eprint/127791

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