Physicians' Academy for Cardiovascular Education

New brain infarcts in AF patients, despite anticoagulation, affect cognitive function

Silent brain infarcts impact on cognitive function in atrial fibrillation

Literature - Kühne M, Krisai P, Coslovsky M, et al. - Eur Heart J. 2022 Jun 6;43(22):2127-2135. doi: 10.1093/eurheartj/ehac020

Introduction and methods


In a recent cross-sectional analysis, cognitive decline in patients with AF was not only associated with clinical strokes but also with silent brain infarcts [1]. While oral anticoagulants (OACs) are highly effective in preventing clinical stroke and have been associated with a lower risk of dementia in AF patients [2], prospective data on the development of brain lesions and their association with cognitive decline in AF patients treated with OACs are lacking.

Aim of the study

The authors investigated the incidence of new (overt and silent) brain lesions in AF patients and the association of new brain lesions with change in cognitive function.


In this prospective, multicenter, observational study, 1227 AF patients from the Swiss Atrial Fibrillation (Swiss-AF) cohort were enrolled, who underwent standardized brain MRI at baseline and after 2 years. Numbers of new small non-cortical infarcts (SNCIs), large non-cortical or any cortical infarcts (LNCCIs), white matter lesions, and microbleeds were quantified. Clinically silent infarcts were defined as a new SNCI/LNCCI on the second MRI scan in patients without a clinical stroke or TIA during follow-up.

The investigators assessed cognitive function at baseline and 2-year follow-up with several validated neurocognitive tests. They also calculated their own developed Swiss-AF Cognitive Construct (CoCo) score, which is composed of 17 differently weighted combined items from these individual neurocognitive tests.


The outcomes were the estimated 2-year risk of each of the lesion types, the associations between a pre-defined set of potential predictors and lesion risks, and the effect of lesions on cognitive test scores.

Main results

New brain lesions

Predictors of new brain lesions

Cognitive function


Over 2 years of follow-up, 5.5% of AF patients had developed a new brain infarct, the majority of which was clinically silent and occurred in anticoagulated patients. New clinically overt and silent brain infarcts were similarly associated with cognitive decline. According to the authors, the results suggest that OAC treatment alone may not be sufficient to prevent vascular brain injury and cognitive decline in all AF patients.


Show references

Find this article online at Eur Heart J.

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