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Updated: Jul 8, 2026
Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Cerebral Microvascular Injury and Physical Function in Older Patients With Atrial Fibrillation: Evidence for
Jocelyn R Spruit1, Dominique E J van Anrooij2, Lennaert A R Zwart3
1Department of Geriatric Medicine, Northwest Hospital, Alkmaar, The Netherlands; Department of Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands; Department of Geriatric Medicine, Dijklander Hospital, Hoorn, The Netherlands.
Insights
Atrial fibrillation (AF) is linked to sex-specific cerebral small vessel disease (CSVD) patterns, impacting physical function. White matter hyperintensities partially mediate this decline, especially in men, highlighting CSVD as a therapeutic target.
Area of Science:
- Neurology
- Cardiology
- Geriatrics
Background:
- Atrial fibrillation (AF) is a known risk factor for cerebrovascular diseases.
- Cerebral small vessel disease (CSVD) encompasses various brain pathologies, including white matter hyperintensities (WMH), lacunes, and microbleeds.
- Previous research suggests a link between AF and CSVD, but sex-specific differences and their impact on functional outcomes remain underexplored.
Purpose of the Study:
- To investigate sex-specific differences in CSVD prevalence and patterns in patients with and without AF.
- To examine the association between AF, CSVD, and cognitive and physical performance.
- To determine if CSVD markers mediate the relationship between AF and functional decline.
Main Methods:
- Observational cross-sectional cohort study of 1044 memory clinic patients.
- Brain MRI was used to assess CSVD markers: WMH (Fazekas ≥2), lacunes (≥1), and microbleeds (≥3).
- Logistic regression and mediation analyses were employed to examine associations and mediating effects.
Main Results:
- AF was associated with increased WMH in men and more microbleeds in women.
- Patients with AF exhibited poorer physical performance (reduced gait speed and Short Physical Performance Battery scores) but not cognitive impairment.
- WMH partially mediated the association between AF and reduced physical performance, with a stronger effect observed in men.
Conclusions:
- AF is associated with distinct sex-specific CSVD patterns in older adults.
- CSVD, particularly WMH, plays a significant role in mediating AF-related physical performance decline, especially in men.
- Targeting CSVD may be crucial for preserving physical function in individuals with AF, necessitating sex-specific risk stratification.
Objectives:
Atrial fibrillation (AF) has been linked to cerebral small vessel disease (CSVD). This study examined the sex-specific differences in CSVD between patients with and without AF and the implications for cognitive and physical performance.
Design:
Observational cross-sectional cohort study.
Setting And Participants:
One thousand forty-four memory clinic patients (mean age, 79.2 ± 6.4 years, 51% men) from the Amsterdam Aging Cohort.
Methods:
Participants underwent standardized geriatric and neuropsychological assessments and magnetic resonance imaging of the brain. CSVD was defined by white matter hyperintensities (WMHs, Fazekas ≥2), ≥1 lacune, and/or ≥3 cerebral microbleeds. Associations between AF, CSVD, cognitive performance, and physical performance were examined using logistic regression. Mediation analyses assessed whether CSVD markers mediated associations between AF and physical or cognitive performance.
Results:
AF prevalence was 15.4% (n = 161). AF showed a significant association with WMH in men (adjusted odds ratio [aOR], 1.95; 95% CI, 1.20-3.15). Women with AF had higher odds of ≥3 cerebral microbleeds (aOR, 1.94; 95% CI, 1.00-3.76). AF was associated with reduced gait speed (aOR, 1.64; 95% CI, 1.14-2.37) and poor physical performance (Short Physical Performance Battery <10; aOR, 2.42; 95% CI, 1.66-3.53) but not with cognitive performance. WMH partially mediated the association between AF and reduced Short Physical Performance Battery (B = 0.27; P = .03), which was even stronger in men (B = 0.57; P = .012) but not with gait speed.
Conclusions And Implications:
In older memory clinic patients, AF was associated with sex-specific CSVD patterns: greater WMH burden in men and more microbleeds in women. WMH substantially mediated AF-related decline in physical performance, particularly in men, suggesting that CSVD is an important pathway linking AF to physical dysfunction. These findings underscore the need for sex-specific risk stratification and highlight CSVD as a therapeutic target to preserve physical function in patients with AF.
