Official journal of the Slovak Society of Cardiology,
Slovak Society of Hypertension and Slovak Association for Cardiac Arrhythmias

Cardiology Letters 2024, 33(4):248-258

Cognitive impairment and atrial fibrillation

Dominik Koreň, Milan Maretta, Zuzana Gdovinová
Neurologická klinika UPJŠ LF a UNLP Košice, Slovenská republika

The most frequent consequences or complications in patients with atrial fibrillation (AF) include the occurrence of ischemic stroke, which is manifested by focal somatic neurodeficit, but often also by the development of non-somatic deficits, such as cognitive impairment. The aim of this review article is to summarize the current understanding of the relationship between FP and the development of cognitive impairment, while attention is paid to the implication of current knowledge in clinical practice in terms of therapeutic and preventive procedures.

Keywords: cognitive disorder; post-stroke cognitive impairment; atrial fibrillation; stroke

Published: April 1, 2024  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Koreň D, Maretta M, Gdovinová Z. Cognitive impairment and atrial fibrillation. Cardiology Letters. 2024;33(4):248-258.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Piccini JP, Hammill BG, Sinner MF, Hernandez AF, Walkey AJ, Benjamin EJ, et al. Clinical course of atrial fibrillation in older adults: the importance of cardiovascular events beyond stroke. Eur Heart J. 2014;35:250-256. Go to original source...
    2. Nesheiwat Z, Goyal A, Jagtap M. Atrial Fibrillation. In: StatPearls. Treasure Island (FL): StatPearls Publishing; April 26, 2023.
    3. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37:2893-2962. Go to original source...
    4. Gleason KT, Nazarian S, Dennison Himmelfarb CR. Atrial Fibrillation Symptoms and Sex, Race, and Psychological Distress: A Literature Review. J Cardiovasc Nurs. 2018;33:137-143. Go to original source...
    5. Staerk L, Sherer JA, Ko D, Benjamin EJ, Helm RH. Atrial Fibrillation: Epidemiology, Pathophysiology, and Clinical Outcomes. Circ Res. 2017;120:1501-1517. Go to original source...
    6. Murphy SJ, Werring DJ. Stroke: causes and clinical features. Medicine (Abingdon). 2020;48:561-566. Go to original source...
    7. Rost NS, Brodtmann A, Pase MP, van Veluw SJ, Biffi A, Muering M, et al. Post-Stroke Cognitive Impairment and Dementia. Circ Res. 2022;130:1252-1271. Go to original source...
    8. Huang YY, Chen SD, Leng XY, Kuo K, Wang ZT, Cui M, et al. PostStroke Cognitive Impairment: Epidemiology, Risk Factors, and Management. J Alzheimers Dis. 2022;86:983-999. Go to original source...
    9. Lo JW, Crawford JD, Desmond DW, Godefroy O, Jokinen H, Mahinrad S, et al. Profile of and risk factors for poststroke cognitive impairment in diverse ethnoregional groups. Neurology. 2019;93:e2257-e2271. Go to original source...
    10. Linz D, Gawalko M, Betz K, Hendriks JM, Lip GYH, Vinter N, et al. Atrial fibrillation: epidemiology, screening and digital health. Lancet Reg Health Eur. 2024;37:100786. Published 2024 Feb 1. doi:10.1016/j.lanepe.2023.100786 Go to original source...
    11. Prince M, Bryce R, Albanese E, Wimo A, Ribeiro W, Ferri CP. The global prevalence of dementia: a systematic review and metaanalysis. Alzheimers Dement. 2013; 9:63-75.e2. doi: 10.1016/j.jalz.2012.11.007 Go to original source...
    12. GBD 2019 Dementia Forecasting Collaborators. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health. 2022;7:e105-e125. doi:10.1016/S2468-2667(21)00249-8 Go to original source...
    13. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation: a major contributor to stroke in the elderly. The Framingham Study. Arch Intern Med. 1987;147:1561-1564. Go to original source...
    14. Kwok CS, Loke YK, Hale R, Potter JF, Myint PK. Atrial fibrillation and incidence of dementia: a systematic review and metaanalysis. Neurology. 2011;76:914-922. Go to original source...
    15. Chopard R, Piazza G, Gale SA, Campia U, Albertsen IE, Kim J, et al. Dementia and Atrial Fibrillation: Pathophysiological Mechanisms and Therapeutic Implications. Am J Med. 2018;131:1408-1417. Go to original source...
    16. Miller J D, Aronis K N, Chrispin J, Patil KD, Marine JE, Martin SS, et al. Obesity, exercise, obstructive sleep apnea, and modifiable atherosclerotic cardiovascular disease risk factors in atrial fibrillation. J Am Coll Cardiol. 2015;66:2899-2906. Go to original source...
    17. Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission (published correction appears in Lancet. 2023;402(10408):1132). Lancet. 2020;396(10248):413-446. Go to original source...
    18. Liao JN, Chao TF, Liu CJ, Wang KL, Chen SJ, Tuan TCh, et al. Risk and prediction of dementia in patients with atrial fibrillation-a nationwide population-based cohort study. Int J Cardiol. 2015;199:25-30. Go to original source...
    19. Kamel H, Healey JS. Cardioembolic Stroke. Circ Res. 2017;120:514526. Go to original source...
    20. Kamel H, Okin PM, Elkind MS, Iadecola C. Atrial Fibrillation and Mechanisms of Stroke: Time for a New Model. Stroke. 2016;47:895-900. Go to original source...
    21. Lim JS, Lee JJ, Woo CW. Post-Stroke Cognitive Impairment: Pathophysiological Insights into Brain Disconnectome from Advanced Neuroimaging Analysis Techniques. J Stroke. 2021;23:297-311. Go to original source...
    22. Ott A, Breteler MM, de Bruyne MC, van Harskamp F, Grobbee DE, Hofman A. Atrial fibrillation and dementia in a population-based study. The Rotterdam Study. Stroke. 1997;28:316-321. Go to original source...
    23. Rivard L, Friberg L, Conen D, Healey JS, Berge T, Boriani G, et al. Atrial Fibrillation and Dementia: A Report From the AF-SCREEN International Collaboration (published correction appears in Circulation. 2022;145:e842). Circulation. 2022;145:392-409. Go to original source...
    24. Kalantarian S, Ay H, Gollub RL, Lee H, Retzepi K, Mansour M, et al. Association between atrial fibrillation and silent cerebral infarctions: a systematic review and meta-analysis. Ann Intern Med. 2014;161:650-658. Go to original source...
    25. Gaita F, Corsinovi L, Anselmino M, Raimondo C, Pianelli M, Toso E, et al. Prevalence of silent cerebral ischemia in paroxysmal and persistent atrial fibrillation and correlation with cognitive function.J Am Coll Cardiol. 2013;62:1990-1997. Go to original source...
    26. Kühne M, Krisai P, Coslovsky M, Rodondi N, Müller A, Beer JH, et al. Silent brain infarcts impact on cognitive function in atrial fibrillation. Eur Heart J. 2022;43:2127-2135. Go to original source...
    27. Dietzel J, Haeusler KG, Endres M. Does atrial fibrillation cause cognitive decline and dementia? Europace. 2018;20:408-419. Go to original source...
    28. Kerr AJ, Simmonds MB, Stewart RA. Influence of heart rate on stroke volume variability in atrial fibrillation in patients with normal and impaired left ventricular function. Am J Cardiol. 1998;82:1496-1500. Go to original source...
    29. Gardarsdottir M, Sigurdsson S, Aspelund T, Rokita H, Launer LJ, Gudnason V, et al. Atrial fibrillation is associated with decreased total cerebral blood flow and brain perfusion. Europace. 2018; 20:1252-1258. Go to original source...
    30. Saglietto A, Scarsoglio S, Ridolfi L, Gaita F, Anselmino M. Higher ventricular rate during atrial fibrillation relates to increased cerebral hypoperfusions and hypertensive events. Sci Rep. 2019; 9:3779. Go to original source...
    31. Lacruz ME, Kluttig A, Hartwig S, Löer M, Tiller D, Greiser KH, et al. Prevalence and Incidence of Hypertension in the General Adult Population: Results of the CARLA-Cohort Study. Medicine (Baltimore). 2015;94(22):e952. Go to original source...
    32. Fantini S, Sassaroli A, Tgavalekos KT, Kornbluth J. Cerebral blood flow and autoregulation: current measurement techniques and prospects for noninvasive optical methods. Neurophotonics. 2016;3:031411. Go to original source...
    33. Shekhar S, Liu R, Travis OK, Roman RJ, Fan F. Cerebral Autoregulation in Hypertension and Ischemic Stroke: A Mini Review. J Pharm Sci Exp Pharmacol. 2017;2017:21-27. Go to original source...
    34. Shi Y, Thrippleton MJ, Makin SD, Marshall I, Geerlings MI, de Craen AJM, et al. Cerebral blood flow in small vessel disease: a systematic review and meta-analysis.J Cereb Blood Flow Metab. 2016; 36:1653-1667. Go to original source...
    35. Zhang J, Liu L, Sun H, Li M, Li Y, Zhao J, et al. Cerebral Microbleeds Are Associated With Mild Cognitive Impairment in Patients With Hypertension. J Am Heart Assoc. 2018;7:e008453. Go to original source...
    36. Saito T, Kawamura Y, Sato N, Kano K, Takahashi K, Asanome A, et al. Non-vitamin K antagonist oral anticoagulants do not increase cerebral microbleeds.J Stroke Cerebrovasc Dis. 2015; 4:1373-1377. Go to original source...
    37. Wagner B, Hert L, Polymeris AA, Schaedelin S, Lieb JM, Seiffge DJ, et al. Impact of type of oral anticoagulants in patients with cerebral microbleeds after atrial fibrillation-related ischemic stroke or TIA: Results of the NOACISP-LONGTERM registry. Front Neurol. 2022;13:964723. Go to original source...
    38. Zhou X, Dudley SC Jr. Evidence for Inflammation as a Driver of Atrial Fibrillation. Front Cardiovasc Med. 2020;7:62. Go to original source...
    39. Wersching H, Duning T, Lohmann H, Mohammadi S, Stehling C, Fobker M, et al. Serum C-reactive protein is linked to cerebral microstructural integrity and cognitive function. Neurology. 2010; 74:1022-1029. Go to original source...
    40. Khan AA, Lip GYH. The prothrombotic state in atrial fibrillation: pathophysiological and management implications. Cardiovasc Res. 2019;115:31-45. Go to original source...
    41. Tian Z, Ji X, Liu J. Neuroinflammation in Vascular Cognitive Impairment and Dementia: Current Evidence, Advances, and Prospects. Int J Mol Sci. 2022;23:6224. Go to original source...
    42. De Guio F, Duering M, Fazekas F, De Leeuw FE, Greenberg SM, Pantoni L, et al. Brain atrophy in cerebral small vessel diseases: Extent, consequences, technical limitations and perspectives: The HARNESS initiative. J Cereb Blood Flow Metab. 2020;40:231-245. Go to original source...
    43. Looi JC, Sachdev PS. Differentiation of vascular dementia from AD on neuropsychological tests. Neurology 1999;53:670678. Go to original source...
    44. Weintraub S, Wicklund AH, Salmon DP. The neuropsychological profile of Alzheimer disease. Cold Spring Harb Perspect Med. 2012;2:a006171. Go to original source...
    45. Iadecola C, Duering M, Hachinski V, Joutel A, Pendlebury ST, Julie A Schneider JA, et al. Vascular Cognitive Impairment and Dementia: JACC Scientific Expert Panel. J Am Coll Cardiol. 2019;73:3326-3344. Go to original source...
    46. Aam S, Einstad MS, Munthe-Kaas R, Lydersen S, Ihle-Hansen H, Knapskog AB, et al. Post-stroke Cognitive ImpairmentImpact of Follow-Up Time and Stroke Subtype on Severity and Cognitive Profile: The Nor-COAST Study. Front Neurol. 2020;11:699. Go to original source...
    47. Petersen RC. Mild cognitive impairment as a diagnostic entity. J Intern Med. 2004;256:183-194. Go to original source...
    48. American Psychiatric Association. DSM-5: Diagnostic and Statistical Manual of Mental Disorders. 5. American Psychiatric Association; Washington, DC: 2013. Go to original source...
    49. Santos MAO, Bezerra LS, Correia CDC, Bruscky IS. Neuropsychiatric symptoms in vascular dementia: Epidemiologic and clinical aspects. Dement Neuropsychol. 2018;12:40-44. Go to original source...
    50. Freitas S, Simões MR, Alves L, Vicente M, Santana I. Montreal Cognitive Assessment (MoCA): validation study for vascular dementia. J Int Neuropsychol Soc. 2012;18:1031-1040. Go to original source...
    51. Chiti G, Pantoni L. Use of Montreal Cognitive Assessment in patients with stroke. Stroke. 2014;45:3135-3140. Go to original source...
    52. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society 2005;53:695-699. Go to original source...
    53. Živanović M, Aracki Trenkić A, Milošević V, Stojanov D, Mišić M Radovanović M, et al. The role of magnetic resonance imaging in the diagnosis and prognosis of dementia. Biomol Biomed. 2023;23:209-224. Go to original source...
    54. Flach C, Muruet W, Wolfe CDA, Bhalla A, Douiri A. Risk and Secondary Prevention of Stroke Recurrence: A Population-Base Cohort Study. Stroke. 2020;51:2435-2444. Go to original source...
    55. Hatala R. Rhythm control in asymptomatic 'early' atrial fibrillation: birth of a new paradigm? Eur Heart J. 2022;43:1231-1233. Go to original source...
    56. Baker LD, Frank LL, Foster-Schubert K, Green PS, Wilkinson ChW, McTiernan A, et al., Effects of aerobic exercise on mild cognitive impairment: a controlled trial Arch Neurol. 2010;67:71-79. Go to original source...
    57. Erickson KI, Hillman C, Stillman CM, Ballard RM, Bloodgood B, Conroy DE, et al. Physical Activity, Cognition, and Brain Outcomes: A Review of the 2018 Physical Activity Guidelines. 2018 PHYSICAL ACTIVITY GUIDELINES ADVISORY COMMITTEE*. Med Sci Sports Exerc. 2019 Jun;51:1242-1251. Go to original source...
    58. Bayles MP, Swank AM, eds. (American College of Sports Medicine). ACSM Guidelines for Exercise Testing and Prescription. Wolters Kluwer; 2018;978-1-4963-3907-2
    59. Davis C, Bryan J, Hodgson J, Murphy K. "Definition of the Mediterranean Diet; a Literature Review." Nutrients 2015;7:9139-9153. Go to original source...
    60. Bach-Faig A, Berry EM, Lairon D, Reguant J, Trichopoulou A, Dernini S, et al. Mediterranean diet pyramid today. Science and cultural updates. Public Health Nutr. 2011;14:2274-2284. Go to original source...
    61. Preventívne postupy MZSR: https://www.standardnepostupy.sk/novy-zoznam-schvalenych-preventivnych-postupov-ppvp/
    62. Tischer TS, Nitschke D, Krause I, Kundt G, Öner A, D'Ancona G, et al. Prevalence and Progression of Cognitive Impairment in Atrial Fibrillation Patients after Treatment with Catheter Ablation or Drug Therapy. Cardiol. Res. Pract. 2019;2019:4-7. Go to original source...
    63. Jin MN, Kim TH, Kang KW, Yu HT, Uhm JS J. Atrial Fibrillation Catheter Ablation Improves 1-Year Follow-Up Cognitive Function, Especially in Patients with Impaired Cognitive Function. Circ. Arrhythmia Electrophysiol. 2019;12:e007197. Go to original source...
    64. Hsieh YC, Chen YY, Chien KL, Chung FP, Lo LW, Chang SL, et al. Catheter Ablation of Atrial Fibrillation Reduces the Risk of Dementia and Hospitalization during a Very Long-Term Follow-Up. Int. J. Cardiol. 2020;304:75-81. Go to original source...
    65. Vázquez M, Santos E, Rodriguez I, Pato A, Vilar M, Arias JC, et al. Assessment of Silent Microembolism by Magnetic Resonance Imaging After Cardioversion in Atrial Fibrillation. Rev. Española Cardiol. 2012;65:139-142. Go to original source...
    66. Lin JC, Li CH, Chen YY, Weng CJ, Chien YS, Wu SJ, et al. Rhythm Control Better Prevents Dementia than Rate Control Strategies in Patients with Atrial Fibrillation-A Nationwide Cohort Study. J. Pers. Med. 2022;12:12. Go to original source...
    67. Damanti S, Pasina L, Cortesi L, Rossi PD, Cesari M. Atrial Fibrillation: Possible Influences of Rate and Rhythm Control Strategy on Cognitive Performance. J. Am. Geriatr. Soc. 2018;66:21782182. Go to original source...
    68. Bodagh N, Yap R, Kotadia I, Sim I, Bhalla A, Somerville P, et al. Impact of Catheter Ablation versus Medical Therapy on Cognitive Function in Atrial Fibrillation: A Systematic Review. J. Interv. Card. Electrophysiol. 2022;65:271-286. Go to original source...
    69. Cacciatore F, Testa G, Langellotto A, Galizia G, Della-Morte D, Gargiulo G, et al. Role of Ventricular Rate Response on Dementia in Cognitively Impaired Elderly Subjects with Atrial Fibrillation: A 10-Year Study. Dement. Geriatr. Cogn. Disord. 2012;34:143148. Go to original source...
    70. Saglietto A, Scarsoglio S, Ridolfi L, Gaita F, Anselmino M. Higher Ventricular Rate during Atrial Fibrillation Relates to Increased Cerebral Hypoperfusions and Hypertensive Events. Sci. Rep. 2019;9: 3779. Go to original source...
    71. Camm AJ, Kirchhof P, Lip GYH, Schotten U, Savelieva I, Ernst S, et al. Guidelines for the Management of Atrial Fibrillation: The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Europace 2010;12:13601420. Go to original source...
    72. Custodio N, Montesinos R, Lira D, Herrera-Pérez E, Bardales Y, Valeriano-Lorenzo L. Mixed dementia: A review of the evidence. Dement Neuropsychol. 2017;11:364-370. Go to original source...
    73. Alber J, Alladi S, Bae HJ, Barton DA, Beckett LA, Bell JM, et al. White matter hyperintensities in vascular contributions to cognitive impairment and dementia (VCID): Knowledge gaps and opportunities. Alzheimers Dement (N Y). 2019;5:107-117. Go to original source...
    74. Series H, Esiri M. Vascular dementia: a pragmatic review. Advances in Psychiatric Treatment, 2012; 18:372-380. Go to original source...
    75. Luchesi BM, Melo BRS, Balderrama P, Martins Gratão AC, Nisihara Chagas MH, Iost Pavarini SC, et al. Prevalence of risk factors for dementia in middle- and older- aged people registered in Primary Health Care. Dement Neuropsychol. 2021;15:239-247. Go to original source...
    76. Do D, Schnittker J. Utilization of Medications With Cognitive Impairment Side Effects and the Implications for Older Adults' Cognitive Function. J Aging Health. 2020;32:1165-1177. Go to original source...

    Return to the content