Cognitive impairment and small vessel disease in atrial fibrillation

Abstract

Objective: to evaluate the impact of various forms of atrial fibrillation (AF) on the development of mild cognitive impairment (MCI) and cerebral small vessel disease.Patients and methods. The study included 31 patients with AF (paroxysmal form – 22 patients, permanent form – 9 patients). Arterial hypertension was diagnosed in 26 patients and diabetes mellitus in 6 patients. All patients were taking direct oral anticoagulants (DOACs). Patients underwent cognitive testing, screening ultrasound examination of the main arteries of the head and neck, MRI on a Siemens Skyra 3 T tomograph according to a protocol including diffusion tensor imaging and perfusion determination. To create a control group of healthy elderly individuals, the open database of clinical and MR data OASIS 3 was used that retrospectively evaluated more than 1000 people over a period of 30 years. Participants whose cognitive status was assessed clinically as "normal cognitive function" were selected.Results and discussion. The frequency of MCI and indicators of cognitive tests did not differ in groups of patients with permanent and paroxysmal forms of AF. The distribution of foci of hyperintense white matter, the thickness of the cerebral cortex also did not differ in patients with different forms of AF. The neuroimaging pattern of cerebral small vessel disease in AF patients without stroke was consistent with population controls.Conclusion. Prescribing DOACs to patients reduces the risk of cognitive impairment of vascular origin development due to the clear and predictable effect of this class of drugs that prevent the development of cerebral embolism.

Keywords

• atrial fibrillation
• mild cognitive impairment
• direct oral anticoagulants
• cerebral small vessel disease
• white matter hyperintensity
• magnetic resonance imaging