Atrial fibrillation, cognition and dementia: A review

Abstract

Atrial fibrillation (AF) is one of the most common types of cardiac arrhythmia, particularly among older adults. AF confers a 5-fold risk for thromboembolic stroke as well as a 2-fold higher risk for congestive heart failure, morbidity, and mortality. Although stroke remains an important and impactful complication of AF, recent studies have shown that AF is independently associated with other neurological disorders, including cognitive impairment and dementia, even after adjusting for prior ischemic stroke. We performed a review of the published literature on the association between AF and cognitive status. Further, we reviewed studies investigating the underlying mechanisms for this association and/or reporting the impact of AF treatment on cognitive function. While most published studies demonstrate associations between AF and impaired cognition, no AF treatment has yet been associated with a reduced incidence of cognitive decline or dementia.

Keywords: Alzheimer's disease; anticoagulants; atrial fibrillation; cognitive decline; dementia; vascular dementia.

Figure 1

Proposed mechanisms for the association of atrial fibrillation and dementia. Both conditions share risk factors such as hypertension, coronary artery disease, congestive heart failure, diabetes mellitus, age. Potential mechanisms include linking atrial fibrillation and cognitive impaurment/dementia include cerebral hypoperfusion, vascular inflammation, cerebral small vessel disease, and brain atrophy.