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Review
. 2023 Apr 22;12(9):3050.
doi: 10.3390/jcm12093050.

The Impact of Atrial Fibrillation Treatment Strategies on Cognitive Function

Neil Bodagh  1 , Irum Kotadia  1 , Ali Gharaviri  2 , Fernando Zelaya  1 , Jonathan Birns  3 , Ajay Bhalla  3 , Peter Sommerville  3 , Steven Niederer  1 , Mark O'Neill  1   3 , Steven E Williams  1   2
Affiliations
Review

The Impact of Atrial Fibrillation Treatment Strategies on Cognitive Function

Neil Bodagh et al. J Clin Med. .

Abstract

There is increasing evidence to suggest that atrial fibrillation is associated with a heightened risk of dementia. The mechanism of interaction is unclear. Atrial fibrillation-induced cerebral infarcts, hypoperfusion, systemic inflammation, and anticoagulant therapy-induced cerebral microbleeds, have been proposed to explain the link between these conditions. An understanding of the pathogenesis of atrial fibrillation-associated cognitive decline may enable the development of treatment strategies targeted towards the prevention of dementia in atrial fibrillation patients. The aim of this review is to explore the impact that existing atrial fibrillation treatment strategies may have on cognition and the putative mechanisms linking the two conditions. This review examines how components of the 'Atrial Fibrillation Better Care pathway' (stroke risk reduction, rhythm control, rate control, and risk factor management) may influence the trajectory of atrial fibrillation-associated cognitive decline. The requirements for further prospective studies to understand the mechanistic link between atrial fibrillation and dementia and to develop treatment strategies targeted towards the prevention of atrial fibrillation-associated cognitive decline, are highlighted.

Keywords: anticoagulation; atrial fibrillation; cognitive decline; dementia; rate control; rhythm control.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Treatment strategies which may affect atrial fibrillation-associated cognitive decline. OSA = obstructive sleep apnoea.
Figure 2
Figure 2
Proposed mechanisms linking atrial fibrillation and cognitive decline.
See this image and copyright information in PMC

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