Neuropsychiatry of atrial fibrillation: dementia and beyond

Figures

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  Figure 1. Bidirectional relationship between atrial fibrillation (AF) and cognitive impairment/dementia. Cardiovascular risk factors (circle) are associated with the development of both AF and dementia. Multiple pathophysiological mechanisms are shared by these conditions (e.g., inflammation, coagulation dysfunction) and contribute to their further progression. CAD, Coronary artery disease; CKD, chronic kidney disease.

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  Figure 2. Potential mechanism linking atrial fibrillation (AF) and neuropsychiatric symptoms. Because of the unpredictability nature of AF and the related impact on lifestyle, people with AF can develop stress, anxiety and depression. In parallel to psychosocial mechanisms, increased oxidative stress and inflammation, neurohormonal activation and autonomic dysfunction alongside hemodynamic perturbations (e.g., atrial dilatation, diastolic dysfunction, changes in cardiac output) can lead to hypo-hyper perfusion events and eventually micro/macrovascular changes with cerebral hypoperfusion and, as a consequence, cognitive and behavioral symptoms. OSA, obstructive sleep apnea; RAAS, renin-angiotensin-aldosterone system.