Relationships between cerebral small vessel diseases markers and cognitive performance in stroke-free patients with atrial fibrillation

Abstract

BackgroundAtrial fibrillation (AF) is related to an increased risk of cognitive dysfunction. Besides clinically overt stroke, AF can damage the brain via several pathophysiological mechanisms. We aimed to assess the potential mediating role of cerebral small vessel disease (SVD) and cognitive performance in individuals with AF.MethodsStroke-free individuals with AF from the cardiological outpatient clinic at West China Hospital of Sichuan University were recruited. Extensive neuropsychological testing tools were assessed including global function, domains of attention, executive functions, learning, and memory. 3 T magnetic resonance imaging (MRI) was used for SVD markers assessment of white matter hyperintensities (WMH), lacunes, cerebral microbleeds (CMBs), and enlarged perivascular spaces (EPVS). The correlation between SVD markers and cognitive measures was analyzed by multivariate linear regression models.ResultsWe finally enrolled 158 participants, of whom 95 (60.1%) were males. In multivariate models, the presence of lacunes independently associated with Montreal Cognitive Assessment (Model 1: ß = 0.52, Model 2: ß = 0.55), Rey Auditory Verbal Learning Test-immediate and delayed recall (Model 1: ß = 0.49; ß = 0.69; Model 2: ß = 0.53; ß = 0.73) as well as Stroop-Acorrect (Model 1: ß = 0.12; Model 2: ß = 0.13), while total WMH severity independently associated with Strooptime-A (Model 1: ß = 0.24; Model 3: ß = 0.27), Strooptime-B (Model 1: ß = 0.17; Model 3: ß = 0.17), Strooptime-C (Model 1: ß = 0.22; Model 3: ß = 0.21) and Shape Trail Test-A (Model 1: ß = 0.17; Model 3: ß = 0.16).ConclusionIn our cohort of stroke-free individuals with AF, lacunes, and WMHs were independently associated with cognitive decline while EPVS and CMBs did not show significance. Assessment of SVD MRI markers might be valuable for cognition risk stratification and facilitate optimal management of patients with AF.

Performance of the walking trail making test in older adults with white matter hyperintensities

“…First, the sample size was small. Second, some aspects, such as delayed recall of the AVLTh, were not chosen in the present study, because patients with WMH were previously found to not show deficits in this domain[ 30 ]. In addition, 3T-WMH volume should be used to quantify WMH in future research.…”

Hotspots and Frontiers of Atrial Fibrillation and Cognitive Dysfunction: a bibliometric and visual analysis

“…On the one hand, atrial brillation may signi cantly increase the risk of stroke, an important risk factor for cognitive dysfunction. On the other hand, even in the absence of stroke, asymptomatic cerebral infarction [20], unidenti able microinfarcts [21], and white matter hyperintensity [22] linked to atrial brillation are also very likely to result in cognitive decline and dementia such as Alzheimer's disease, and the related pathogeneses are still being con rmed and investigated. Standardized treatment [23] of atrial brillation and anticoagulation management [24,25] may have a speci c effect on delaying cognitive decline in patients.…”

“…listed the top ten authors related to AF and cognitive dysfunction, all of whom had published no less than 15 articles. Lip GYH (University of Liverpool, England) (48) is the most proli c author, followed by Gottesman RF (Johns Hopkins University, USA)(24), Mcmanus DD (University of Massachusetts, USA)(22), Alonso A (Emory University, USA) (20), Bunch TJ (University of Utah, USA)(20). Eight of the top ten authors were from the United States, the other two came from the UK and South Korea, and all belonged to different organizations.…”