Cognitive Impairment Associated With Atrial Fibrillation: A Meta-Analysis
Does atrial fibrillation (AF) increase the risk of cognitive impairment?
This was a meta-analysis of 21 observational studies that examined the association between AF and cognitive impairment. The studies included 14,747 patients with AF and 70,967 patients without AF.
Overall, AF was significantly associated with a 40% increase in the relative risk of cognitive impairment. A subgroup analysis demonstrated there was not a significant association between AF and Alzheimer disease, whereas AF was associated with a 72% increase in the relative risk of vascular dementia. The significant association between AF and cognitive impairment was independent of a history of stroke.
The authors concluded that AF is associated with an increased risk of cognitive impairment regardless even in patients without prior stroke.
There are several possible reasons for the association between AF and cognitive impairment: 1) shared risk factors for both conditions (e.g., hypertension, diabetes); 2) clinical and subclinical strokes caused by thromboembolism; 3) cerebral hypoperfusion caused by a reduction in cardiac output related to AF; and 4) a proinflammatory state associated with AF that promotes cerebral lesions. The link between AF and cognitive impairment may provide a reason to prefer a rhythm-control strategy over a rate-control strategy in patients with AF, even in those who are asymptomatic.
Keywords: Thromboembolism, Stroke, Dementia, Vascular, Cardiac Output, Risk Factors, Cognition Disorders, Hypertension, Diabetes Mellitus
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