To investigate whether higher Fazekas scores, indicative of white matter hyperintensity (WMH) severity, predict cognitive decline and frailty in older adults with atrial fibrillation (AF) over a 2-year follow-up period.

Cognitive decline and frailty are common in aging populations and present significant public health challenges. WMHs as measured by the Fazekas score, have been associated with cognitive impairment and physical frailty, yet the relationship between WMH, cognitive decline, and frailty in individuals with AF remains underexplored.

A total of 86 participants aged 65 years or older with diagnosed AF were included in this analysis. WMH were assessed using MRI and CT scans, and Fazekas scores were graded on a scale from 0 to 3. Cognitive function was measured using the Montreal Cognitive Assessment (MoCA) at baseline, 1 year, and 2 years. Frailty was evaluated using the Fried Frailty Phenotype at the same intervals. Multivariate binomial logistic regression models were used to examine the association between Fazekas scores (grouped as 0–1 and 2–3) and cognitive decline or frailty, adjusting for demographic, clinical, and geriatric variables.

At baseline, the mean MoCA scores were lower for participants with higher Fazekas scores, indicating worse cognitive function. After adjusting for clinical and demographic factors, participants with Fazekas grades 2–3 were 2.62 times more likely to experience cognitive decline (OR: 2.62; 95% CI: 1.02–6.7; p = 0.03) and 2.68 times more likely to become frail (OR: 2.68; 95% CI: 1.2–6.1; p = 0.02) compared to those with Fazekas grades 0–1 longitudinally over two-years. 

Higher Fazekas scores are significant predictors of both cognitive decline and frailty in older adults with AF over a 2-year follow-up. These findings suggest that WMH, as quantified by the Fazekas score, may serve as an important marker for identifying older adults at increased risk of cognitive and physical deterioration.