State of cerebral hemodynamics in patients with cognitive dysfunction associated with atrial fibrillation

Abstract

The aim of the study was to cerebral hemodynamics in patients with cognitive dysfunction associated with atrial fibrillation (AF). Patients and methods. Fifty-six patients aged 40–75 years (the mean age was 62.7±6.3 years) with nonvalvular AF caused by ischemic heart disease were examined. In 30 (53.6%) patients AF was permanent; in 26 (46.4%) patients, it was either persistent or paroxysmal. The exclusion criteria were as follows: past transient ischemic attacks, stroke or myocardial infarction, and severe somatic diseases. All patients with AF were evaluated for cognitive functions (using the short scale for assessing the mental status), auditory memory and associative memory (using the Schulte test), and emotional background (using the Hospital Anxiety and Depression Scale). Ultrasonography of the extracranial and intracranial vessels and registration of the average linear blood flow velocity (LBFV) was performed. Results. Cognitive impairments (CI) were diagnosed in 38 patients who entered the main group; patients with AF without CI comprised the control group. 82.6% of patients of the main group were diagnosed with constrictive lesion of the carotid (CA) and vertebral (VA) arteries of various severity; the isolated lesion of the CA was observed in 23.7% of patients, the isolated lesion of the VA in 18.4%; multiple lesions of the CA and VA in 69.4%; and the hemodynamically significant lesion, in 30.3%. In patients of the control group, constrictive lesions of the extracranial arteries were observed in 65.5% of cases. Condition of the major arteries of the head (MAH) significantly affects the LBFV parameters of the intracranial arteries. In patients with multiple lesions of the CA and VA, the LBFV in the intracranial vessels was much lower than that in patients with isolated lesions of the CA and VA. The relation between the rate and severity of constrictive lesions of the MAH and the presence of AF accompanied with CI was noted in patients. Cerebral hypoperfusion, stenosis of the MAH, and lesions of the small cerebral arteries play an important role in pathogenesis of CI in patients with AF. Changes in the cerebral hemodynamics were stronger pronounced in patients with cognitive dysfunction associated with AF. To prevent the development and progression of vascular dementia, patients with AF need complex treatment by a cardiologist and a neurologist.