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Covert Embolic Brain Infarcts, Remote Cortical Thinning, and Cognitive Impairment in Atrial Fibrillation: An Analysis

Tim Sinnecker1,2, Stefanie Aeschbacher3,4, Anne Springer3,4

  • 1Department of Neurology, University Hospital Basel, Basel, Switzerland, tim.sinnecker@usb.ch.

Cerebrovascular Diseases (Basel, Switzerland)
|July 20, 2026
PubMed

Insights

In patients with atrial fibrillation (AF), embolic brain infarcts and white matter hyperintensities (WMH) are linked to brain atrophy and cognitive decline. Embolic infarcts appear to significantly disrupt brain networks, contributing to cognitive impairment.

Area of Science:

  • Neurology
  • Cardiology
  • Radiology

Background:

  • Atrial fibrillation (AF) patients have high rates of covert brain infarcts and white matter hyperintensities (WMH).
  • These conditions increase the risk of cognitive decline and dementia, but the underlying causes are unclear.
  • This study investigates the link between lesion location and brain structure/function in AF patients.

Purpose of the Study:

  • To explore the relationship between embolic brain infarcts, WMH location, and remote cortical volume in AF patients.
  • To assess the impact of WMH and embolic infarcts on global cognitive function using voxel-based lesion-symptom mapping.

Main Methods:

  • Analysis of a prospective, multicenter cohort study (Swiss-AF) including 1716 AF patients with MRI data.
  • Used LASSO regression to associate brain lesions (embolic infarcts, WMH) in white matter tracts with remote cortical volume.
  • Employed voxel-based lesion-symptom mapping to evaluate the effect of WMH location relative to embolic infarcts on cognition.

Main Results:

  • WMH were present in 99% and embolic infarcts in 23% of patients.
  • Embolic infarcts explained more variability in remote cortical volumes than WMH, despite smaller volumes.
  • While WMH initially correlated with cognitive function, this association diminished significantly when embolic infarcts were considered.

Conclusions:

  • Covert embolic brain infarcts and WMH in AF patients are associated with remote cortical atrophy and reduced cognitive performance.
  • Disruption of brain networks by embolic infarcts appears to be a key factor in cognitive impairment among AF patients.
  • Embolic infarcts play a more critical role than WMH in driving cognitive deficits in this population.
Abstract

Keywords:
Atrial fibrillationCognitive impairmentCortical thinningCovert brain infarcts

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