Abstract
Atrial fibrillation (AF) is the most common chronic cardiac arrhythmia with an increasing prevalence over time mainly because of population aging. It is well established that the presence of AF increases the risk of stroke, heart failure, sudden death, and cardiovascular morbidity. In the last two decades several reports have shown an association between AF and cognitive function, ranging from impairment to dementia. Ischemic stroke linked to AF is a well-known risk factor and predictor of cognitive decline. In this clinical scenario, the risk of stroke might be reduced by oral anticoagulation. However, recent data suggest that AF may be a predictor of cognitive impairment and dementia also in the absence of stroke. Cerebral hypoperfusion, reduced brain volume, microbleeds, white matter hyperintensity, neuroinflammation, and genetic factors have been considered as potential mechanisms involved in the pathogenesis of AF-related cognitive dysfunction. However, a cause-effect relationship remains still controversial. Consequently, no therapeutic strategies are available to prevent AF-related cognitive decline in stroke-free patients. This review will analyze the potential mechanisms leading to cognitive dysfunction in AF patients and examine the available data on the impact of a sinus rhythm restoration and maintenance strategy in reducing the risk of cognitive decline.
Highlights
Atrial fibrillation (AF) is a common chronic cardiac arrhythmia with an increasing prevalence over time mainly because of population aging, peaking at 10–17%incidence from the age of 80 years and older [1,2]
In the absence of optimal anticoagulation, a rhythm control strategy is associated with lower probability of cognitive impairment
The strongest evidence supports the role of stroke as the principal risk factor for cognitive impairment, it has been established that AF is a risk factor for cognitive dysfunction independently from stroke [8,63]
Summary
Atrial fibrillation (AF) is a common chronic cardiac arrhythmia with an increasing prevalence over time mainly because of population aging, peaking at 10–17%incidence from the age of 80 years and older [1,2]. The presence of AF increases the risk of stroke up to five-fold [3], heart failure [4,5] and death [6,7]. Epidemiological evidence indicates an association between AF, cognitive impairment and dementia [8,9,10,11,12,13]. Others [10,11,12,15,16,17,18,19,20,21,22].Stroke-related AF is a well-known risk factor and predictor of cognitive impairment and dementia [23]. Some observations suggest that AF-induced brain ischemia and silent brain infarcts [24,25,26]
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