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Cognitive Impairment Associated With Atrial Fibrillation: A Meta-Analysis
Study Questions:
Does atrial fibrillation (AF) increase the risk of cognitive impairment?
Methods:
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.
Results:
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.
Conclusions:
The authors concluded that AF is associated with an increased risk of cognitive impairment regardless even in patients without prior stroke.
Perspective:
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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