Atrial Fibrillation and Dementia: A Report From the AF-SCREEN International Collaboration

Léna Rivard, Leif Friberg, David Conen, Jeffrey S Healey, Trygve Berge, Giuseppe Boriani, Axel Brandes, Hugh Calkins, A John Camm, Lin Yee Chen, Josep Lluis Clua Espuny, Ronan Collins, Stuart Connolly, Nikolaos Dagres, Mitchell S V Elkind, Johan Engdahl, Thalia S Field, Bernard J Gersh, Taya V Glotzer, Graeme J HankeyJoseph A Harbison, Karl Georg Haeusler, Mellanie T Hills, Linda S B Johnson, Boyoung Joung, Paul Khairy, Paulus Kirchhof, Derk Krieger, Gregory Y H Lip, Maja-Lisa Løchen, Malini Madhavan, Georges H Mairesse, Joan Montaner, George Ntaios, Terence J Quinn, Michiel Rienstra, Mårten Rosenqvist, Roopinder K Sandhu, Breda Smyth, Renate B Schnabel, Stavros Stavrakis, Sakis Themistoclakis, Isabelle C Van Gelder, Ji-Guang Wang, Ben Freedman

Research output: Contribution to journalReview articlepeer-review

3 Citations (Web of Science)

Abstract

Growing evidence suggests a consistent association between atrial fibrillation (AF) and cognitive impairment and dementia that is independent of clinical stroke. This report from the AF-SCREEN International Collaboration summarizes the evidence linking AF to cognitive impairment and dementia. It provides guidance on the investigation and management of dementia in patients with AF on the basis of best available evidence. The document also addresses suspected pathophysiologic mechanisms and identifies knowledge gaps for future research. Whereas AF and dementia share numerous risk factors, the association appears to be independent of these variables. Nevertheless, the evidence remains inconclusive regarding a direct causal effect. Several pathophysiologic mechanisms have been proposed, some of which are potentially amenable to early intervention, including cerebral microinfarction, AF-related cerebral hypoperfusion, inflammation, microhemorrhage, brain atrophy, and systemic atherosclerotic vascular disease. The mitigating role of oral anticoagulation in specific subgroups (eg, low stroke risk, short duration or silent AF, after successful AF ablation, or atrial cardiopathy) and the effect of rhythm versus rate control strategies remain unknown. Likewise, screening for AF (in cognitively normal or cognitively impaired patients) and screening for cognitive impairment in patients with AF are debated. The pathophysiology of dementia and therapeutic strategies to reduce cognitive impairment warrant further investigation in individuals with AF. Cognition should be evaluated in future AF studies and integrated with patient-specific outcome priorities and patient preferences. Further large-scale prospective studies and randomized trials are needed to establish whether AF is a risk factor for cognitive impairment, to investigate strategies to prevent dementia, and to determine whether screening for unknown AF followed by targeted therapy might prevent or reduce cognitive impairment and dementia.

Original languageEnglish
Pages (from-to)392-409
Number of pages18
JournalCirculation
Volume145
Issue number5
DOIs
Publication statusPublished - 1 Feb 2022

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