Atrial Fibrillation and Dementia: Exploring the Association, Defining Risks and Improving Outcomes

Abstract

AF is strongly associated with a spectrum of cranial injuries including stroke and dementia. Dementia risk is seen in patients with and without a prior stroke and includes idiopathic forms of dementia, such as Alzheimer’s disease. The initiation, use and efficacy of anticoagulation have been shown in multiple observational trials to have an impact on dementia risk. Cerebral hypoperfusion during AF can result in cognitive decline and patients with cranial atherosclerosis may have unique susceptibility. Therapies to carefully control the ventricular rate and catheter ablation have been shown in observational trials to lower dementia risk. There is a need for further research in multiple areas and the observational trials will require prospective trials confirmation. Recent guidelines for AF have advocated the initiation of effective anticoagulation, the treatment of associated disease conditions that may influence the progression of AF and catheter ablation, with long-term management of risk factors to lower risk of dementia.

Cognitive Function and Atrial Fibrillation: From the Strength of Relationship to the Dark Side of Prevention. Is There a Contribution from Sinus Rhythm Restoration and Maintenance?

“…There is also evidence supporting that both cerebral blood flow and brain perfusion, assessed by phase-contrast MRI, improve after cardioversion [124,125]. This evidence further supports the hypothesis that also the time-period in AF may influence the risk to develop cognitive impairment [17].…”

“…Epidemiological evidence indicates an association between AF, cognitive impairment and dementia [8,9,10,11,12,13]. The great impact of this issue is demonstrated by the several articles that have been published only in the last 12 months from the present review paper by Heart Rhythm Associations [14] and others [10,11,12,15,16,17,18,19,20,21,22]. Stroke-related AF is a well-known risk factor and predictor of cognitive impairment and dementia [23].…”

“…The relationship between AF and cognitive impairment/dementia has been reported in several studies [11,15,16,17,19,20,62,63]. The large cross-sectional Rotterdam Study was one of the first pieces of evidence to describe this association [64].…”

Cerebral Embolism Beyond Atrial Fibrillation: Interatrial Block

“…These mechanisms include the most obvious, such as symptomatic ischemic stroke and silent cerebral infarcts/micro-infarcts [47], to cerebral hemorrhages and cerebral hypoperfusion due to hemodynamic alterations. In fact, reductions in cardiac output and decreases in diastolic cerebral arterial flow might play a role [48]. In the case of advanced IAB, the association seems to be very similar.…”

Impact of the Pattern of Atrial Fibrillation on Stroke Risk and Mortality

“…Those observations have valuable relevance because potential therapeutic opportunities to reduce dementia risk, including early and effective use of OACs and strategies to improve brain perfusion through rhythm and rate control approaches. [ 61 , 62 ] However, prospective trials are needed to evaluate these therapeutic opportunities.…”