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

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial Fibrillation (n=2439). Intervention: Atrial fibrillation vs. No atrial fibrillation. Primary outcome: Prevalence of MRI-detected brain infarcts (LNCCI and/or SNCI) (OR 1.78, 95% CI 1.30-2.44, p=0.0003).

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 U. 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; for the Swiss-AF Investigators eMBA; 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; Principal Investigator; Local Principal Investigator; 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; Study nurses; Tanja Flückiger; Cindy Groen; Lukas Ehrsam; Sven Hellrigl; Alexandra Nuoffer; Damiana Rakovic; Nathalie Schwab; Rylana Wenger; Tu Hanh Zarrabi Saffari; Local Principal Investigators; Nicolas Rodondi; Stadtspital Triemli Zurich; 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; Local Principal Investigator; Andreas S. Müller; Kantonspital Baden; Corinne Friedli; Silke Kuest; Karin Scheuch

doi:10.1038/s43856-026-01389-w

January 27, 2026SHILAP Revista de lepidopterologíaOpen Access

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

View Full Paper

Ask AI

Bookmark

Share

Key result

AF linked to ~78% higher prevalence of ischemic brain infarcts and lower cognitive function.

OR 1.78
95% CI 1.30-2.44
P=0.0003
n=2,439

Figures

Why the study?

Is atrial fibrillation associated with increased brain lesions and lower cognitive function compared to patients without atrial fibrillation?

Key Points

Patients with atrial fibrillation exhibit higher rates of ischemic brain infarcts and white matter hyperintensities, which coincide with lower overall cognitive performance.
Brain infarcts occurred in 40.1% of patients with atrial fibrillation versus 24.0% of controls, accompanied by a substantial direct reduction in cognitive test performance.
Multicenter prospective study evaluations with magnetic resonance imaging demonstrate direct cognitive decline, highlighting that atrial fibrillation acts beyond vascular brain lesions.

Study Design

Type

Cohort (n=2,439)

Multicenter

Yes

Structured PICO

Is atrial fibrillation associated with increased brain lesions and lower cognitive function compared to patients without atrial fibrillation?

P

Population

2,439 adults aged 45 and older, with and without atrial fibrillation, who underwent brain MRI and cognitive testing to assess the relationship between arrhythmias, brain lesions, and cognition.

E

Exposure

Atrial fibrillation (exposure)

C

Comparator

No atrial fibrillation

O

Outcome

Brain structure (large non-cortical and cortical infarcts, small non-cortical infarcts, white matter hyperintensities, and microbleeds) assessed by MRI, and cognition assessed by Montreal Cognitive Assessment (MoCA)surrogate

Main Result

Odds Ratio: 1.78 (95% CI 1.3–2.44)

Absolute Event Rate: 40.1% vs 24%

p-value: p=0.0003

Atrial fibrillation is associated with a higher prevalence of silent ischemic brain infarcts and white matter hyperintensities, as well as lower cognitive function, primarily through a direct effect rather than mediated by brain lesions.

Limitations

Missing MRI data for a substantial number of patients due to cardiac devices and claustrophobia
Potential for unmeasured confounding despite adjustment for comorbidities
Cross-sectional analysis of baseline data limits definitive causal conclusions

Implication

AF may warrant cognitive screening beyond stroke prevention; leaves open whether direct effects are modifiable in prospective trials.

Abstract

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.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Krisai et al. (2026) conducted a cohort in Atrial Fibrillation (n=2,439). Atrial fibrillation vs. No atrial fibrillation was evaluated on Prevalence of MRI-detected brain infarcts (LNCCI and/or SNCI) (OR 1.78, 95% CI 1.30-2.44, p=0.0003). Atrial fibrillation was associated with a higher prevalence of ischemic brain infarcts (OR 1.78) and lower cognitive function, primarily through a direct effect rather than mediated by brain lesions.

synapsesocial.com/papers/69a75acec6e9836116a211c2 https://doi.org/10.1038/s43856-026-01389-w

View Full Paper

Ask AI

Bookmark

Share

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

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Keep reading

More related papers

More from SHILAP Revista de lepidopterología

Keep reading

More related papers

More from SHILAP Revista de lepidopterología