A factor score reflecting cognitive functioning in patients from the Swiss Atrial Fibrillation Cohort Study (Swiss-AF)

et al. 2022

European Heart Journal

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Aims We aimed to investigate the association of clinically overt and silent brain lesions with cognitive function in atrial fibrillation (AF) patients. Methods and results We enrolled 1227 AF patients in a prospective, multicentre cohort study (Swiss-AF). Patients underwent standardized brain magnetic resonance imaging (MRI) at baseline and after 2 years. We quantified new small non-cortical infarcts (SNCIs) and large non-cortical or cortical infarcts (LNCCIs), white matter lesions (WML), and microbleeds (Mb). Clinically, silent infarcts were defined as new SNCI/LNCCI on follow-up MRI in patients without a clinical stroke or transient ischaemic attack (TIA) during follow-up. Cognition was assessed using validated tests. The mean age was 71 years, 26.1% were females, and 89.9% were anticoagulated. Twenty-eight patients (2.3%) experienced a stroke/TIA during 2 years of follow-up. Of the 68 (5.5%) patients with ≥1 SNCI/LNCCI, 60 (88.2%) were anticoagulated at baseline and 58 (85.3%) had a silent infarct. Patients with brain infarcts had a larger decline in cognition [median (interquartile range)] changes in Cognitive Construct score [−0.12 (−0.22; −0.07)] than patients without new brain infarcts [0.07 (−0.09; 0.25)]. New WML or Mb were not associated with cognitive decline. Conclusion In a contemporary cohort of AF patients, 5.5% had a new brain infarct on MRI after 2 years. The majority of these infarcts was clinically silent and occurred in anticoagulated patients. Clinically, overt and silent brain infarcts had a similar impact on cognitive decline. Clinical Trial Registration ClinicalTrials.gov Identifier: NCT02105844, https://clinicaltrials.gov/ct2/show/NCT02105844 Key question The incidence of clinically overt and silent brain infarcts, white matter lesions, and microbleeds, and their impact on cognition in atrial fibrillation (AF) patients are not known. Key finding Over 2 years of follow-up, 5.5% of AF patients developed new brain infarcts, with the majority of them being clinically silent and occurring in anticoagulated patients. New clinically overt and silent brain infarcts were similarly associated with cognitive decline. Take-home message In a contemporary cohort of AF patients, new brain infarcts are frequent despite a high anticoagulation rate. Our data suggest that anticoagulation alone may not be sufficient to prevent brain damage and cognitive decline in all AF patients.

Section: Methodsmentioning

confidence: 99%

Silent brain infarcts impact on cognitive function in atrial fibrillation

Kühne

Krisai

et al. 2022

European Heart Journal

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“…Next to executive functioning and processing speed, the difference between AF subgroups was also present in the cognitive construct (CoCo) score ( 19 ). It has previously been shown that the CoCo score is likely to be more granular and more sensitive to detect small changes in cognitive function ( 19 ) which may be missed when examining each neurocognitive test alone ( 12 , 40 ).…”

Section: Discussionmentioning

confidence: 99%

“…The cognitive test battery consisted of five validated, widely used cognitive tests administered at each follow-up. The test battery included the Montreal Cognitive Assessment (MoCA) ( 22 ), Trail Making Test Part A (TMT-A) ( 23 , 24 ) Trail Making Test Part B (TMT-B) (TMT results calculated as number of correct connections per second) ( 23 , 24 ), Semantic Fluency test (SF) ( 25 ) and the Digit Symbol Substitution Test (DSST) ( 26 , 27 ), described in detail elsewhere ( 19 ). All cognitive tests were administered in a paper-pencil format or, during the coronavirus disease 2019 (COVID-19) pandemic, in part (i.e., MoCA and SF) by telephone.…”

Section: Methodsmentioning

confidence: 99%

“…Additionally, two derived cognitive measures were used, i.e., the ratio TMT-B / TMT-A and the Cognitive Construct (CoCo) derived from the total of 17 items comprised in the five validated neuropsychological tests used in the Swiss-AF cohort study. A previous study of the group has shown that using the CoCo score increased measurement sensitivity and allows to detect subtle changes in cognitive function ( 19 ). Cognitive drop was defined as an observed score of at least one SD below the individual's age-education standardized cognitive test scores at baseline ( 29 ).…”

Section: Methodsmentioning

confidence: 99%

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Mid-term changes in cognitive functions in patients with atrial fibrillation: a longitudinal analysis of the Swiss-AF cohort

Wueest

Zuber

Front. Cardiovasc. Med.

et al. 2023

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BackgroundLongitudinal association studies of atrial fibrillation (AF) and cognitive functions have shown an unclear role of AF-type and often differ in methodological aspects. We therefore aim to investigate longitudinal changes in cognitive functions in association with AF-type (non-paroxysmal vs. paroxysmal) and comorbidities in the Swiss-AF cohort.MethodsSeven cognitive measures were administered up to five times between 2014 and 2022. Age-education standardized scores were calculated and association between longitudinal change in scores and baseline AF-type investigated using linear mixed-effects models. Associations between AF-type and time to cognitive drop, an observed score of at least one standard deviation below individual's age-education standardized cognitive scores at baseline, were studied using Cox proportional hazard models of each cognitive test, censoring patients at their last measurement. Models were adjusted for baseline covariates.Results2,415 AF patients (mean age 73.2 years; 1,080 paroxysmal, 1,335 non-paroxysmal AF) participated in this Swiss multicenter prospective cohort study. Mean cognitive scores increased longitudinally (median follow-up 3.97 years). Non-paroxysmal AF patients showed smaller longitudinal increases in Digit Symbol Substitution Test (DSST), Cognitive Construct Score (CoCo)and Trail Making Test part B (TMT-B) scores vs. paroxysmal AF patients. Diabetes, history of stroke/TIA and depression were associated with worse performance on all cognitive tests. No differences in time to cognitive drop were observed between AF-types in any cognitive test.ConclusionThis study indicated preserved cognitive functioning in AF patients, best explained by practice effects. Smaller practice effects were found in non-paroxysmal AF patients in the DSST, TMT-B and the CoCo and could indicate a marker of subtle cognitive decline. As diabetes, history of stroke/TIA and depression—but not AF-type—were associated with cognitive drop, more attention should be given to risk factors and underlying mechanisms of AF.

“…Digit Symbol Substitution Test (DSST) explores cognitive aspects such as information processing speed, visuomotor coordination, and attention [19]. The cognitive construct (CoCo) score is a score previously derived from the individual components of all neurocognitive tests performed in Swiss-AF (MoCA, TMT, SFT, DSST) using latent factor analysis and summarizes global cognitive performance [29].…”

Section: Neurocognitive Functionmentioning

confidence: 99%

Physical activity and brain health in patients with atrial fibrillation

Herber

Aeschbacher

et al. 2022

Euro J of Neurology

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Background and purpose Vascular brain lesions, such as ischemic infarcts, are common among patients with atrial fibrillation (AF) and are associated with impaired cognitive function. The role of physical activity (PA) in the prevalence of brain lesions and cognition in AF has not been investigated. Methods Patients from the multicenter Swiss‐AF cohort study were included in this cross‐sectional analysis. We assessed regular exercise (RE; at least once weekly) and minutes of weekly PA using a validated questionnaire. We studied associations with ischemic infarcts, white matter hyperintensities, cerebral microbleeds, and brain volume on brain magnetic resonance imaging and with global cognition measured with a cognitive construct (CoCo) score. Results Among 1490 participants (mean age = 72 ± 9 years), 730 (49%) engaged in RE. In adjusted regression analyses, RE was associated with a lower prevalence of ischemic infarcts (odds ratio [OR] = 0.78, 95% confidence interval [CI] = 0.63–0.98, p = 0.03) and of moderate to severe white matter hyperintensities (OR = 0.78, 95% CI = 0.62–0.99, p = 0.04), higher brain volume (β‐coefficient = 10.73, 95% CI = 2.37–19.09, p = 0.01), and higher CoCo score (β‐coefficient = 0.08, 95% CI = 0.03–0.12, p < 0.001). Increasing weekly PA was associated with higher brain volume (β‐coefficient = 1.40, 95% CI = 0.65–2.15, p < 0.001). Conclusions In AF patients, RE was associated with a lower prevalence of ischemic infarcts and of moderate to severe white matter disease, with larger brain volume, and with better cognitive performance. Prospective studies are needed to investigate whether these associations are causal. Until then, our findings suggest that patients with AF should be encouraged to remain physically active.