May 8, 2020 – A new clinical study found that patients withatrial fibrillation (AF)尽管服用口腔防治，但仍然经历了临床沉默脑梗塞的发病率很高。无声的脑梗塞显着与认知下降相关。瑞士心房颤动队列的结果（SWISS-AF）试验呈作为一部分的临床临床试验心律社会（HRS）2020 Science virtual meeting.
AF patients have a high risk of cognitive dysfunction and dementia, in part due to their high risk of ischemic stroke. To help mitigate the risk of an ischemic stroke, many patients with AF are prescribed oral anticoagulation. Clinically silent brain infarcts can be hard to detect in patients and have a similar impact on cognitive decline as an actual stroke. The incidence of silent brain infarcts in anticoagulated patients and whether they impact cognitive function is currently unknown. The Swiss-AF study sought to better understand the role clinically silent brain infarcts play in cognitive decline in AF patients.
The multicenter observational cohort study enrolled 1,227 patients aged ≥65 with previously documented AF. The mean age at baseline was 71.5 ± 8.4 years, and 26 percent were women. Patients underwent brain magnetic resonance imaging (MRI) at baseline and after two years of follow-up. Brain infarcts were quantified in a central core laboratory. New infarcts were defined as lesions present on the follow-up MRI scan but not at baseline, while clinically silent infarcts were defined as new infarcts in patients without a clinical stroke between the two MRI studies.
In theSwiss-AF学习，84 percent of study participants received oral anticoagulation. Nonetheless, 5.5 percent of the participants had a new brain infarct after two years of follow-up. Of the 68 patients with new brain infarcts, 58 (85 percent) had a clinically silent event, 59 (87) were taking oral anticoagulation during the follow-up period, and 51 (75 percent) had a clinically silent brain infarct while taking oral anticoagulation. Patients with new brain infarcts had a stronger decline in cognitive function than patients without new brain infarcts.
“谈到我们对临床中风和AF之间的联系方式，到目前为止，我们所知道的只是冰山一角。这种临床研究表明，即使在没有经历中风，为什么AF患者患有AF患者的认知下降率较高，并提供临床领域更好地了解沉默的脑病变对认知衰退的影响，“铅作者说David Conen, M.D.，MPH，McMaster大学心脏病学和医学系副教授。“虽然许多AF患者受益于口服抗凝血剂，但在一些患者中可能需要考虑额外的治疗，以防止沉默的脑梗塞。我们的希望是，这些结果将有助于医生提前治疗患者中的治疗方案，并帮助减轻认知下降，痴呆和中风的风险。“
这项研究的作者呼吁更多的恐怖主义风险保险法案ls to further study the long-term consequences and impacts of silent brain infarcts in AF patients. Through additional research, the authors also hope to better understand which risk factors are associated with new silent brain infarcts.