Association Between Silent Brain Infarcts and Cognitive Function: A Systematic Review and Meta-Analysis

Abstract Background and Purpose: Silent brain infarct (SBI), which has traditionally been considered clinically silent, has been proposed as a subclinical risk marker for future cognitive function decline. Methods: We conducted a systematic review of literature in the Cochrane Library, MEDLINE, EMBASE, and the China National Knowledge Infrastructure database. Results: In the end, 19 case-control studies, comprising 6712 participants, and 3 prospective cohort studies comprising 4433 participants, met all inclusion criteria and were included in the systematic review. Meta-analysis of 9 studies showed that SBI was an important factor in cognitive function decline (Mini-Mental State score) (standardized mean difference −.47, 95% confidence interval; −.72 to −.22). Another meta-analysis of 4 studies reported the SBI was an independent factor in cognitive dysfunction (Montreal Cognitive Assessment Scale) (standardized mean difference −3.36, 95% confidence interval; −5.90 to −.82). Ten studies further reported that SBI was associated with decreases in specific areas of cognitive function. Conclusions: These results suggest that rather than being clinically silent, SBI might be a factor inducing cognitive dysfunction.