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Canadian Journal of Cardiology

Mechanisms and clinical manifestations of cognitive decline in atrial fibrillation patients: potential implications for preventing dementia

  • Steffen Blum
    Affiliations
    Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland;

    Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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  • David Conen
    Correspondence
    Address for correspondence: David Conen, MD MPH Population Health Research Institute 237 Barton Street East Hamilton Ontario, Canada Phone: +1 905 522-1155
    Affiliations
    Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
    Search for articles by this author
Published:October 14, 2022DOI:https://doi.org/10.1016/j.cjca.2022.10.013

      Abstract

      Growing evidence suggests an independent association between atrial fibrillation (AF) and cognitive decline. AF patients face an about 1.5 -fold increased risk of cognitive decline as compared to the general population. Among post-stroke AF patients, the risk of cognitive decline is even higher with an estimated 3-fold increase. This article provides a narrative review on the current evidence and highlights gaps in knowledge and areas for future research. While earlier studies hypothesized that the association between AF and cognitive decline is mainly a consequence of previous ischemic strokes, more recent evidence also suggests such an association in AF patients without a history of clinical stroke. As both AF and cognitive decline mainly occur among elderly individuals, it is not surprising that both entities share multiple risk factors. In addition to clinically overt ischemic strokes, silent brain infarcts and other brain injury are likely mechanisms for the increased risk of cognitive decline among AF patients. Oral anticoagulation for stroke prevention in AF patients with additional stroke risk factors is one of the only proven therapies to prevent brain injury. Whether a broader use of oral anticoagulation, or more intense anticoagulation in some patients are beneficial in this context needs to be addressed in future studies. Although direct studies are lacking, it is reasonable to recommend optimal treatment of co-morbidities and risk factors for the prevention of cognitive decline and dementia.
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