Atrial Fibrillation and Dementia: A Comprehensive Literature Review

Atrial fibrillation (AF) and dementia commonly co-occur and pose significant challenges to public health, particularly in aging populations. While the heightened risk of stroke in AF undoubtedly contributes to neurocognitive injury, accumulating evidence suggests that stroke alone does not explain the full extent of cognitive decline in individuals with AF. Shared risk factors such as advancing age, hypertension, and diabetes, as well as pathophysiological mechanisms that include silent cerebral infarcts, chronic hypoperfusion, inflammatory pathways, and cerebral microbleeds, appear to drive this multifaceted relationship. Increasing data from observational cohorts, randomized trials, and meta-analyses underscore the potential benefits of anticoagulation, rhythm control, and lifestyle interventions in mitigating these neurocognitive risks, though notable gaps in research remain. This review provides a comprehensive examination of the epidemiology, pathophysiological mechanisms, and current therapeutic strategies for AF-related cognitive impairment. By evaluating emerging evidence-including data on anticoagulation timing, AF ablation, and cognitive screening-we highlight critical areas in need of further investigation to inform clinical practice and improve outcomes for this vulnerable population.