Mid-term changes in cognitive functions in patients with atrial fibrillation: a longitudinal analysis of the Swiss-AF cohort

Alexandra S Wueest; Priska Zuber; Michael Coslovsky; Nikki Rommers; Nicolas Rodondi; Baris Gencer; Giorgio Moschovitis; Maria Luisa De Perna; Juerg H Beer; Tobias Reichlin; Philipp Krisai; Anne Springer; David Conen; Annina Stauber; Andreas S Mueller; Rebecca E Paladini; Michael Kuhne; Stefan Osswald; Andreas U Monsch; Leo H Bonati

doi:10.3389/fcvm.2023.1212587

Mid-term changes in cognitive functions in patients with atrial fibrillation: a longitudinal analysis of the Swiss-AF cohort

Front Cardiovasc Med. 2023 Aug 2:10:1212587. doi: 10.3389/fcvm.2023.1212587. eCollection 2023.

Authors

Alexandra S Wueest^#^{1

2}, Priska Zuber^#³, Michael Coslovsky^{4

5

6}, Nikki Rommers⁶, Nicolas Rodondi^{7

8}, Baris Gencer⁷, Giorgio Moschovitis⁹, Maria Luisa De Perna⁹, Juerg H Beer¹⁰, Tobias Reichlin¹¹, Philipp Krisai^{4

5}, Anne Springer^{5

6}, David Conen¹², Annina Stauber¹³, Andreas S Mueller¹³, Rebecca E Paladini^{4

5}, Michael Kuhne^{4

5}, Stefan Osswald^{4

5}, Andreas U Monsch¹, Leo H Bonati^{14

15}

Affiliations

¹ University Department of Geriatric Medicine FELIX PLATTER, Memory Clinic, Basel, Switzerland.
² Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland.
³ Division of Cognitive Neuroscience, Faculty of Psychology, University of Basel, Basel, Switzerland.
⁴ Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland.
⁵ Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland.
⁶ Department of Clinical Research, University of Basel, University Hospital Basel, Basel, Switzerland.
⁷ Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
⁸ Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
⁹ Division of Cardiology, Ente Ospedaliero Cantonale (EOC), Cardiocentro Ticino Institute, Regional Hospital of Lugano, Lugano, Switzerland.
¹⁰ Department of Medicine, Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Zürich, Switzerland.
¹¹ Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
¹² Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
¹³ Department of Cardiology, Triemli Hospital Zürich, Zürich, Switzerland.
¹⁴ Department of Neurology, University of Basel, University Hospital Basel, Basel, Switzerland.
¹⁵ Department of Research, Reha Rheinfelden, Rheinfelden, Switzerland.

^# Contributed equally.

Abstract

Background: Longitudinal association studies of atrial fibrillation (AF) and cognitive functions have shown an unclear role of AF-type and often differ in methodological aspects. We therefore aim to investigate longitudinal changes in cognitive functions in association with AF-type (non-paroxysmal vs. paroxysmal) and comorbidities in the Swiss-AF cohort.

Methods: Seven cognitive measures were administered up to five times between 2014 and 2022. Age-education standardized scores were calculated and association between longitudinal change in scores and baseline AF-type investigated using linear mixed-effects models. Associations between AF-type and time to cognitive drop, an observed score of at least one standard deviation below individual's age-education standardized cognitive scores at baseline, were studied using Cox proportional hazard models of each cognitive test, censoring patients at their last measurement. Models were adjusted for baseline covariates.

Results: 2,415 AF patients (mean age 73.2 years; 1,080 paroxysmal, 1,335 non-paroxysmal AF) participated in this Swiss multicenter prospective cohort study. Mean cognitive scores increased longitudinally (median follow-up 3.97 years). Non-paroxysmal AF patients showed smaller longitudinal increases in Digit Symbol Substitution Test (DSST), Cognitive Construct Score (CoCo)and Trail Making Test part B (TMT-B) scores vs. paroxysmal AF patients. Diabetes, history of stroke/TIA and depression were associated with worse performance on all cognitive tests. No differences in time to cognitive drop were observed between AF-types in any cognitive test.

Conclusion: This study indicated preserved cognitive functioning in AF patients, best explained by practice effects. Smaller practice effects were found in non-paroxysmal AF patients in the DSST, TMT-B and the CoCo and could indicate a marker of subtle cognitive decline. As diabetes, history of stroke/TIA and depression-but not AF-type-were associated with cognitive drop, more attention should be given to risk factors and underlying mechanisms of AF.

Keywords: Swiss-AF; atrial fibrillation; cognitive function; longitudinal cohort study; practice effect.

Grants and funding

The Swiss-AF study is supported by grants of the Swiss National Science Foundation (grant numbers 33CS30_148474, 33CS30_177520, 32473B_176178, and 32003B_197524), the Swiss Heart Foundation, the Foundation for Cardiovascular Research Basel (FCVR), and the University of Basel.