Atrial Fibrillation and Dementia : A Report From the AF-SCREEN International Collaboration
(2022) In Circulation 145(5). p.392-409- 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... (More)
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.
(Less)
- author
- organization
- publishing date
- 2022-02
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- atrial fibrillation, cognitive dysfunction, dementia
- in
- Circulation
- volume
- 145
- issue
- 5
- pages
- 18 pages
- publisher
- Lippincott Williams & Wilkins
- external identifiers
-
- pmid:35100023
- scopus:85123974674
- ISSN
- 1524-4539
- DOI
- 10.1161/CIRCULATIONAHA.121.055018
- language
- English
- LU publication?
- yes
- id
- 2e076f08-56a2-44e5-87e0-a054dc343ac2
- date added to LUP
- 2022-04-07 14:08:28
- date last changed
- 2024-06-21 10:10:53
@article{2e076f08-56a2-44e5-87e0-a054dc343ac2,
abstract = {{<p>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.</p>}},
author = {{Rivard, Léna and Friberg, Leif and Conen, David and Healey, Jeffrey S. and Berge, Trygve and Boriani, Giuseppe and Brandes, Axel and Calkins, Hugh and Camm, A. John and Yee Chen, Lin and Lluis Clua Espuny, Josep and Collins, Ronan and Connolly, Stuart and Dagres, Nikolaos and Elkind, Mitchell S.V. and Engdahl, Johan and Field, Thalia S. and Gersh, Bernard J. and Glotzer, Taya V. and Hankey, Graeme J. and Harbison, Joseph A. and Georg Haeusler, Karl and Hills, Mellanie T. and Johnson, Linda S.B. and Joung, Boyoung and Khairy, Paul and Kirchhof, Paulus and Krieger, Derk and Lip, Gregory Y.H. and Løchen, Maja Lisa and Madhavan, Malini and Mairesse, Georges H. and Montaner, Joan and Ntaios, George and Quinn, Terence J. and Rienstra, Michiel and Rosenqvist, Mårten and Sandhu, Roopinder K. and Smyth, Breda and Schnabel, Renate B. and Stavrakis, Stavros and Themistoclakis, Sakis and Van Gelder, Isabelle C. and Wang, Ji Guang and Freedman, Ben}},
issn = {{1524-4539}},
keywords = {{atrial fibrillation; cognitive dysfunction; dementia}},
language = {{eng}},
number = {{5}},
pages = {{392--409}},
publisher = {{Lippincott Williams & Wilkins}},
series = {{Circulation}},
title = {{Atrial Fibrillation and Dementia : A Report From the AF-SCREEN International Collaboration}},
url = {{http://dx.doi.org/10.1161/CIRCULATIONAHA.121.055018}},
doi = {{10.1161/CIRCULATIONAHA.121.055018}},
volume = {{145}},
year = {{2022}},
}