Brain atrophy and cognitive function in atrial fibrillation: a subanalysis of the SKAF study
Bibliographic record
Abstract
Abstract Background Cognitive function in patients with non-valvular atrial fibrillation (NVAF) tends to decline compared to patients without NVAF, even in the absence of symptomatic stroke or overt dementia. While previous studies have suggested an association between NVAF, and silent cerebral ischemia and microbleeds, the mechanisms linking NVAF to cognitive impairment remain unclear. Brain atrophy has been hypothesized as a potential contributor to cognitive dysfunction in NVAF patients, but its impact and clinical significance require further investigation. This study aimed to evaluate the relationship between brain atrophy and cognitive function in patients with NVAF. Methods The SKAF study is a prospective, investigator-initiated, multicenter, observational study involving Japanese patients with NVAF aged 60 years or older. We planned to enroll 200 NVAF patients with no history of symptomatic stroke or dementia, including those receiving anticoagulant therapy with edoxaban or not, and 100 patients with sinus rhythm for comparison. Participants underwent brain magnetic resonance imaging (MRI) and cognitive function assessment, including the Montreal Cognitive Assessment (MoCA), at enrollment and after 24 months. We analyzed cerebral atrophy using MRI. Results The study enrolled 310 patients (age: 72.1±6.5 years; male: 191 [61.6%]; NVAF: 213 [68.7%]). The mean CHA2DS2-VASc score in the NVAF group was 2.6±1.2. There was no significant difference between the NVAF group and the control group in the prevalence of silent ischemic stroke or silent microbleeds on MRI across the entire cohort. At enrollment, there was no significant difference in the MoCA score between the two groups (NVAF: 24.4±3.4, control: 25.2±2.9, P=0.054), and no difference in the extent of gray matter atrophy (NVAF: 3.5±1.6%, control: 3.4±2.1%, P=0.63). After 24 months, cognitive function in the NVAF group declined significantly compared to the control group (NVAF: 24.2±3.8, control: 25.5±3.2, P<0.01), while the extent of gray matter atrophy in the NVAF group remained no different from that in the control group (NVAF: 3.9±2.7%, control: 3.7±2.0%, P=0.68). Conclusion The extent of gray matter atrophy was not directly related to cognitive function in patients with NVAF. These findings suggest that brain atrophy may not be the primary driver of cognitive decline in NVAF, and other factors, such as microvascular dysfunction or neuroinflammatory processes, may play a more significant role.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".