TY - JOUR
T1 - Atrial Fibrillation and Dementia
T2 - A Report From the AF-SCREEN International Collaboration
AU - Rivard, Léna
AU - Friberg, Leif
AU - Conen, David
AU - Healey, Jeffrey S.
AU - Berge, Trygve
AU - Boriani, Giuseppe
AU - Brandes, Axel
AU - Calkins, Hugh
AU - Camm, A. John
AU - Yee Chen, Lin
AU - Lluis Clua Espuny, Josep
AU - Collins, Ronan
AU - Connolly, Stuart
AU - Dagres, Nikolaos
AU - Elkind, Mitchell S.V.
AU - Engdahl, Johan
AU - Field, Thalia S.
AU - Gersh, Bernard J.
AU - Glotzer, Taya V.
AU - Hankey, Graeme J.
AU - Harbison, Joseph A.
AU - Georg Haeusler, Karl
AU - Hills, Mellanie T.
AU - Johnson, Linda S.B.
AU - Joung, Boyoung
AU - Khairy, Paul
AU - Kirchhof, Paulus
AU - Krieger, Derk
AU - Lip, Gregory Y.H.
AU - Løchen, Maja Lisa
AU - Madhavan, Malini
AU - Mairesse, Georges H.
AU - Montaner, Joan
AU - Ntaios, George
AU - Quinn, Terence J.
AU - Rienstra, Michiel
AU - Rosenqvist, Mårten
AU - Sandhu, Roopinder K.
AU - Smyth, Breda
AU - Schnabel, Renate B.
AU - Stavrakis, Stavros
AU - Themistoclakis, Sakis
AU - Van Gelder, Isabelle C.
AU - Wang, Ji Guang
AU - Freedman, Ben
N1 - Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/2/1
Y1 - 2022/2/1
N2 - 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.
AB - 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.
KW - atrial fibrillation
KW - cognitive dysfunction
KW - dementia
UR - http://www.scopus.com/inward/record.url?scp=85123974674&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85123974674&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.121.055018
DO - 10.1161/CIRCULATIONAHA.121.055018
M3 - Review article
C2 - 35100023
AN - SCOPUS:85123974674
SN - 0009-7322
VL - 145
SP - 392
EP - 409
JO - Circulation
JF - Circulation
IS - 5
ER -