Abstract
We appreciated much for Dr. Cerit's comments on our article. Evidence from meta-analysis conducted by Kalantarian, et al.,[1] has suggested that AF is associated with a high risk of cognitive impairment (CI) and dementia (D), with or without a history of clinical stroke. Several mechanisms have been considered for the relationship of AF and CI. One explanation is the presence of the same risk factors such as hypertension, heart failure, diabetes mellitus in the both of conditions. Another potential mechanism is that AF comprises all the components of Virchoff's triade (hyper-coagulable state in AF, statis of blood in remodeled left atrium and structural injury of the heart) that leads to thrombus formation in left atrium/left atrial appendage and finally to clinical and subclinical strokes. Other potential mechanisms include: brain hypo-perfusion due to beat-to-beat variability in the length of the cardiac cycle and reduced cardiac output, the pro-inflammatory state in AF and peri-ventricular white matter lesions.
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