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Background <p>The interrelationships between atrial fibrillation (AF), brain lesions and cognitive function are poorly understood. We aimed to investigate the relationship of AF with brain lesions and cognition.</p> Methods <p>We enrolled 1,480 patients with and 959 without AF in a multicenter prospective study (Swiss-AF; NCT02105844). We assessed brain structure, and cognition using the Montreal Cognitive Assessment (MoCA). Brain magnetic resonance imaging (MRI) was performed to assess large non-cortical and cortical infarcts (LNCCI), small non-cortical infarcts (SNCI), white matter hyperintensities (WMH), and microbleeds. Using causal mediation analyses, we investigated the direct (lesion-independent) and indirect (lesion-mediated) effects of AF on cognition.</p> Results <p>Mean age in AF patients is 75.0 vs. 74.2 years in no-AF patients, 28.6% vs. 36.9% are female, and comorbidities are comparable. The prevalence of MRI-detected brain infarcts (LNCCI and/or SNCI) is 40.1% in AF patients vs. 24.0% in no-AF patients, adjusted OR (95% CI): 1.78 (1.30; 2.44), p = 0.0003. WMH (Fazekas ≥2) are more prevalent in AF patients (59.2% vs 44.4%), adjusted OR (95% CI): 2.03 (1.50; 2.77), p = 4.6e-06. The mean MoCA score is 25.3 in AF patients and 26.4 in no-AF patients. In mediation analysis, the total effect of AF on cognition is −1.05 MoCA points, decomposed into a direct effect of −0.99 and an indirect, lesion-mediated, effect of −0.06 points.</p> Conclusions <p>The prevalence of ischemic brain infarcts and WMH is higher in patients with AF than without AF despite comparable comorbidities. AF is associated with lower cognitive function, primarily through a direct effect rather than mediated by brain lesions.</p> <p></p>

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Ischemic brain infarcts, white matter hyperintensities, and cognitive impairment are increased in patients with Atrial Fibrillation

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  • 发表日期：

    2026年1月27日

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  • Philipp Krisai,
  • Stefanie Aeschbacher,
  • Michael Coslovsky,
  • Nikki Rommers,
  • Tobias Reichlin,
  • Andreas S. Müller,
  • Jürg H. Beer,
  • Peter Ammann,
  • Angelo Auricchio,
  • Giorgio Moschovitis,
  • Richard Kobza,
  • Dipen Shah,
  • Marcello Di Valentino,
  • Giulio Conte,
  • Georg Ehret,
  • Elisa Hennings,
  • Andreas Monsch,
  • Rebecca E. Paladini,
  • Nicolas Rodondi,
  • Laurent Roten,
  • Matthias Schwenkglenks,
  • Christian Sticherling,
  • Patrick Badertscher,
  • Christine S. Zuern,
  • Tim Sinnecker,
  • Marco Duering,
  • Felix Mahfoud,
  • Leo H. Bonati,
  • David Conen,
  • Stefan Osswald,
  • Michael Kühne,
  • Steffen Blum,
  • Désirée Carmine,
  • Ludvig Dahlheim,
  • Corinne Girroy,
  • Andreas Gasser,
  • Ruben Kerler,
  • Vincent Meier,
  • Christine Meyer-Zürn,
  • Pascal B. Meyre,
  • Andreas U. Monsch,
  • Christian Müller,
  • Raffaele Peter,
  • Adrian Schweigler,
  • Gian Völlmin,
  • Priska Zuber,
  • Drahomir Aujesky,
  • Urs Fischer,
  • Juerg Fuhrer,
  • Simon Jung,
  • Heinrich Mattle,
  • Seraina Netzer,
  • Luise Adam,
  • Carole Elodie Aubert,
  • Martin Feller,
  • Axel Loewe,
  • Elisavet Moutzouri,
  • Claudio Schneider,
  • Tanja Flückiger,
  • Cindy Groen,
  • Lukas Ehrsam,
  • Sven Hellrigl,
  • Alexandra Nuoffer,
  • Damiana Rakovic,
  • Nathalie Schwab,
  • Rylana Wenger,
  • Tu Hanh Zarrabi Saffari,
  • Nicolas Rodondi,
  • Alain Bernheim,
  • Roger Dillier,
  • Michèle Deubelbeiss,
  • Franz Eberli,
  • Christine Franzini,
  • Daniel Hofer,
  • Raban Jeger,
  • Isabel Juchli,
  • Claudia Liedtke,
  • Samira Murugiah,
  • Jacqueline Nadler,
  • Thayze Obst,
  • Jasmin Roth,
  • Fiona Schlomowitsch,
  • Xiaoye Schneider,
  • Peter Sporns,
  • Katrin Studerus,
  • Noreen Tynan,
  • Dominik Weishaupt,
  • Caroline Wiederkehr,
  • Andreas Müller,
  • Corinne Friedli,
  • Silke Kuest,
  • Karin Scheuch,
  • Denise Hischier,
  • Nicole Bonetti,
  • Alexandra Grau,
  • Jonas Villinger,
  • Eva Laube,
  • Marcel Frick,
  • Stefanie Leuenberger,
  • Franziska Rutz,
  • Jürg-Hans Beer,
  • Adriana Anesini,
  • Cristina Camporini,
  • Maria Luce Caputo,
  • Rebecca Peronaci,
  • Francois Regoli,
  • Martina Ronchi,
  • Roman Brenner,
  • David Altmann,
  • Karin Fink,
  • Michaela Gemperle,
  • Jessica Meier,
  • Mathieu Firmann,
  • Sandrine Foucras,
  • Daniel Hayoz,
  • Martine Rime,
  • Benjamin Berte,
  • Kathrin Bühler,
  • Amir Jadidi,
  • Virgina Justi,
  • Frauke Kellner-Weldon,
  • Melanie Koch,
  • Brigitta Mehmann,
  • Sonja Meier,
  • Myriam Roth,
  • Andrea Ruckli-Kaeppeli,
  • Ian Russi,
  • Kai Schmidt,
  • Mabelle Young,
  • Elia Rigamonti,
  • Carlo Cereda,
  • Alessandro Cianfoni,
  • Maria Luisa De Perna,
  • Jane Frangi-Kultalahti,
  • Patrizia Assunta Mayer Melchiorre,
  • Anica Pin,
  • Serena Staglianò,
  • Tatiana Terrot,
  • Luisa Vicari,
  • Hervé Gallet,
  • Elise Guillermet,
  • Francois Lazeyras,
  • Karl-Olof Lovblad,
  • Patrick Perret,
  • Philippe Tavel,
  • Nathalie Lauriers,
  • Marie Méan,
  • Alessandra Pia Porretta,
  • Sandrine Salzmann,
  • Jürg Schläpfer,
  • Andrea Grêt,
  • Jan Novak,
  • Sandra Vitelli,
  • Frank-Peter Stephan,
  • Augusto Gallino,
  • Marcello Di Valentino,
  • Helena Aebersold,
  • Fabienne Foster,
  • Marco Düring,
  • Tim Sinnecker,
  • Anna Altermatt,
  • Michael Amann,
  • Petra Huber,
  • Manuel Hürbin,
  • Esther Ruberte,
  • Alain Thöni,
  • Jens Würfel,
  • Vanessa Zuber,
  • Michael Coslovsky,
  • Pia Neuschwander,
  • Patrick Simon,
  • Ramun Schmid,
  • Christian Baumann,
  • Nico Ruckstuhl

摘要

Background

The interrelationships between atrial fibrillation (AF), brain lesions and cognitive function are poorly understood. We aimed to investigate the relationship of AF with brain lesions and cognition.

Methods

We enrolled 1,480 patients with and 959 without AF in a multicenter prospective study (Swiss-AF; NCT02105844). We assessed brain structure, and cognition using the Montreal Cognitive Assessment (MoCA). Brain magnetic resonance imaging (MRI) was performed to assess large non-cortical and cortical infarcts (LNCCI), small non-cortical infarcts (SNCI), white matter hyperintensities (WMH), and microbleeds. Using causal mediation analyses, we investigated the direct (lesion-independent) and indirect (lesion-mediated) effects of AF on cognition.

Results

Mean age in AF patients is 75.0 vs. 74.2 years in no-AF patients, 28.6% vs. 36.9% are female, and comorbidities are comparable. The prevalence of MRI-detected brain infarcts (LNCCI and/or SNCI) is 40.1% in AF patients vs. 24.0% in no-AF patients, adjusted OR (95% CI): 1.78 (1.30; 2.44), p = 0.0003. WMH (Fazekas ≥2) are more prevalent in AF patients (59.2% vs 44.4%), adjusted OR (95% CI): 2.03 (1.50; 2.77), p = 4.6e-06. The mean MoCA score is 25.3 in AF patients and 26.4 in no-AF patients. In mediation analysis, the total effect of AF on cognition is −1.05 MoCA points, decomposed into a direct effect of −0.99 and an indirect, lesion-mediated, effect of −0.06 points.

Conclusions

The prevalence of ischemic brain infarcts and WMH is higher in patients with AF than without AF despite comparable comorbidities. AF is associated with lower cognitive function, primarily through a direct effect rather than mediated by brain lesions.