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Atrial Fibrillation and Cognitive Function
Study Questions:
What is the effect of anticoagulation on cognitive decline and dementia in patients with atrial fibrillation (AF)?
Methods:
The authors provide an overview of the current knowledge on the relationship between AF, cognitive impairment and decline, and dementia and the possible role of anticoagulation for the prevention of dementia in patients with AF.
Results:
There is strong evidence from many prospective registries and studies that AF is associated with cognitive impairment, cognitive decline, and dementia. This also applies to patients without prior stroke. Such an association, however, does not necessarily imply a causal relationship, as there is very likely a multifactorial interaction with various cardiovascular risk factors involved (e.g., blood pressure control and renal function changes). The AF patient’s risk profile is also dynamic, and many risk factors change over time; many of the reported associations are based on baseline risk and have not tracked temporal changes in risk. There is only indirect evidence that effective anticoagulation in AF reduces the risk of cognitive impairment and dementia.
Conclusions:
The authors concluded that the data are sufficient to regard AF as an independent cardiovascular risk factor for accelerated cognitive impairment and dementia.
Perspective:
This review suggests that there are sufficient data supporting AF as an independent cardiovascular risk factor for accelerated cognitive impairment and dementia. Clinical ischemic stroke is only one aspect of AF-associated brain ischemia with the most likely mechanism linking AF and cognitive impairment being covert embolism to the brain causing silent cerebral macro- and microinfarcts. Chronic cerebral hypoperfusion is also a possibility. Although use of anticoagulation appears justified, it remains unproven thus far that anticoagulation, which is very effective for reducing clinical stroke, also reduces cognitive decline and dementia in AF patients. The ongoing BRAIN-AF (Blinded Randomized Trial of Anticoagulation to Prevent Ischemic Stroke and Neurocognitive Impairment in AF; NCT02387229) trial is exploring the efficacy of rivaroxaban as compared to standard of care in reducing stroke, transient ischemic attack, and neurocognitive decline.
Keywords: Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Cognition, Blood Pressure, Brain Ischemia, Dementia, Embolism, Ischemic Attack, Transient, Primary Prevention, Risk Factors, Stroke, Vascular Diseases
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