Silent cerebral microvascular disease and the longitudinal risk of cognitive decline in atrial fibrillation

The SKAF study aimed to investigate the incidence of asymptomatic cerebrovascular disorders and cognitive decline in patients with nonvalvular atrial fibrillation (NVAF). We enrolled patients with NVAF aged ≥ 60 years and those with sinus rhythm (SR) for comparison. We collected the head magnetic resonance imaging test and Montreal Cognitive Assessment (MoCA) data at baseline and 24 months follow-up. The primary endpoint was the composite of silent ischemic stroke and microbleeding, and the secondary endpoint was cognitive decline, both over the 24 months of follow-up. In total, 313 patients were enrolled. The SR and NVAF groups comprised 99 and 213 patients, respectively (male, 193 [62%]; age, 72.2 ± 6.5 years). The composite of silent ischemic stroke and microbleeding showed no significant difference between the two groups (17.4% vs. 17.4%; p = 1.00). However, the NVAF group exhibited a significantly larger decline in cognition changes in MoCA score than the SR group (- 1.04 vs. 0,000; p = 0.041). The risk of silent cerebral microvascular disease was equivalent between patients with SR and NVAF. Clinically, NVAF affected cognitive decline.