Cognitive dysfunction in atrial fibrillation

Malini Madhavan, Jonathan Graff-Radford, Jonathan P. Piccini, Bernard J. Gersh

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Atrial fibrillation (AF) is the most common arrhythmia in adults, and its incidence and prevalence increase with age. The risk of cognitive impairment and dementia also increases with age, and both AF and cognitive impairment or dementia share important risk factors. In meta-analyses of published studies, AF is associated with a 2.4-fold and 1.4-fold increase in the risk of dementia in patients with or without a history of stroke, respectively. This association is independent of shared risk factors such as hypertension and diabetes mellitus. Neuroimaging has illustrated several potential mechanisms of cognitive decline in patients with AF. AF is associated with increased prevalence of silent cerebral infarcts, and more recent data also suggest an increased prevalence of cerebral microbleeds with AF. AF is also associated with a pro-inflammatory state, and the relationship between AF-induced systemic inflammation and dementia remains to be investigated. Preliminary reports indicate that anticoagulation medication including warfarin can reduce the risk of cognitive impairment in patients with AF. Catheter ablation, increasingly used to maintain sinus rhythm in patients with AF, is associated with the formation of new silent cerebral lesions. The majority of these lesions are not detectable after 1 year, and insufficient data are available to evaluate their effect on cognition. Large prospective studies are urgently needed to confirm the association between AF and dementia, to elucidate the associated mechanisms, and to investigate the effect of anticoagulation and rhythm control on cognition.

Original languageEnglish (US)
JournalNature Reviews Cardiology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Atrial Fibrillation
Dementia
Cognition
Cognitive Dysfunction
Catheter Ablation
Warfarin
Neuroimaging
Meta-Analysis
Cardiac Arrhythmias
Diabetes Mellitus
Stroke
Prospective Studies
Hypertension
Inflammation
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Cognitive dysfunction in atrial fibrillation. / Madhavan, Malini; Graff-Radford, Jonathan; Piccini, Jonathan P.; Gersh, Bernard J.

In: Nature Reviews Cardiology, 01.01.2018.

Research output: Contribution to journalArticle

Madhavan, Malini ; Graff-Radford, Jonathan ; Piccini, Jonathan P. ; Gersh, Bernard J. / Cognitive dysfunction in atrial fibrillation. In: Nature Reviews Cardiology. 2018.
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