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

TY - JOUR

T1 - Atrial Fibrillation and Dementia: 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

PY - 2022/2

Y1 - 2022/2

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/physiopathology

KW - Dementia/physiopathology

KW - Humans

KW - Risk Factors

U2 - 10.1161/CIRCULATIONAHA.121.055018

DO - 10.1161/CIRCULATIONAHA.121.055018

M3 - SCORING: Review article

C2 - 35100023

VL - 145

SP - 392

EP - 409

JO - CIRCULATION

JF - CIRCULATION

SN - 0009-7322

IS - 5

ER -