Atrial Fibrillation, Cognitive Decline, and Dementia: an Epidemiologic Review

PURPOSE OF REVIEW: Atrial fibrillation (AF) and dementia are both prevalent diseases in aging societies, which exert a great economic burden worldwide. Although a handful of epidemiologic studies have indicated that AF is independently associated with faster cognitive decline and a higher risk of dementia, there is still a lack of comprehensive understanding of the observed association. In this review, we summarize evidence from major epidemiologic studies concerning AF-related cognitive decline and dementia, the potential mechanisms underlying their association, and the cognitive benefits of treatment options. RECENT FINDINGS: A large majority of population-based longitudinal studies have consistently shown an independent association of AF with cognitive decline and dementia with varying effect sizes, depending on the age of the study population and the presence of clinical stroke. The underlying pathways linking AF to cognitive phenotypes may involve systemic inflammation, cerebral hypoperfusion, and cerebral small vessel disease and microemboli. However, current evidence is insufficient to support the potential benefits of AF treatment in reducing risk of cognitive decline and dementia. SUMMARY: Current epidemiologic research suggests that AF contributes to cognitive decline and dementia, independent of a history of stroke. Further work is warranted to elucidate the potential mechanisms underlying this association, and more well-designed studies are needed to explore the possible cognitive benefits of different therapeutic options in patients with AF.