Cognitive Impairment Associated With Atrial Fibrillation

Kalantarian, Shadi; Stern, Theodore A.; Mansour, Moussa; Ruskin, Jeremy N.

doi:10.7326/0003-4819-158-5-201303050-00007

Cited by 365 publications

(290 citation statements)

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“…Several different kinds of observational works-such as meta-analyses [12][13][14], reviews [15,16], and cross-sectional [17][18][19], cohort and longitudinal [20][21][22][23][24][25] studies-confirm an independent association between AF and cognitive decline at differing grades of severity.…”

Section: Introductionmentioning

confidence: 99%

Alteration of cerebrovascular haemodynamic patterns due to atrial fibrillation: an in silico investigation

Scarsoglio

Saglietto

Anselmino

et al. 2017

J. R. Soc. Interface.

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There has recently been growing evidence that atrial fibrillation (AF), the most common cardiac arrhythmia, is independently associated with the risk of dementia. This represents a very recent frontier with high social impact for the number of individuals involved and for the expected increase in AF incidence in the next 40 years. Although a number of potential haemodynamic processes, such as microembolisms, altered cerebral blood flow, hypoperfusion and microbleeds, arise as connecting links between the two pathologies, the causal mechanisms are far from clear. An in silico approach is proposed that combines in sequence two lumped-parameter schemes, for the cardiovascular system and the cerebral circulation. The systemic arterial pressure is obtained from the cardiovascular system and used as the input for the cerebral circulation, with the aim of studying the role of AF on the cerebral haemodynamics with respect to normal sinus rhythm (NSR), over a 5000 beat recording. In particular, the alteration of the haemodynamic (pressure and flow rate) patterns in the microcirculation during AF is analysed by means of different statistical tools, from correlation coefficients to autocorrelation functions, crossing times, extreme values analysis and multivariate linear regression models. A remarkable signal alteration, such as a reduction in signal correlation (NSR, about 3 s; AF, less than 1 s) and increased probability (up to three to four times higher in AF than in NSR) of extreme value events, emerges for the peripheral brain circulation. The described scenario offers a number of plausible cause-effect mechanisms that might explain the occurrence of critical events and the haemodynamic links relating to AF and dementia.

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Section: Introductionmentioning

confidence: 99%

Alteration of cerebrovascular haemodynamic patterns due to atrial fibrillation: an in silico investigation

Scarsoglio

Saglietto

Anselmino

et al. 2017

J. R. Soc. Interface.

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“…Relationships between N-terminal pro-B-type natriuretic peptide (NT-proBNP) and left atrium dilatation are also reported [19][20][21]. The evaluation of cognitive function in every patient with AF is, therefore, indicated due to these complicated relationships, mainly for the purpose of diagnosing subclinical vascular injury and determining the patient's ability to comply with physician recommendations [22].…”

Section: Introductionmentioning

confidence: 99%

Links between parameters of long-term latent memory and progression from paroxysmal to permanent atrial fibrillation during a five-year observation period. A preliminary study

Mietła

Budzyński²,

Bieliński³

et al. 2016

Kardiol Pol

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A b s t r a c t Background and aim:As cognitive function is the most vulnerable human feature, its impairment may precede the occurrence of symptoms of cardiovascular system disorders, e.g. atrial fibrillation (AF). In this way, cognitive impairment may not only be a complication of AF, but also a marker of its progression. This study aims to test this hypothesis. Methods:Of 35 patients with AF, 23 (66%) had paroxysmal and 12 (34%) had permanent arrhythmia at the start of the study. At both the start of the study and after 5.86 ± 3.7-7.05 years of follow-up, the following neuropsychological tests were performed using the Beck Depression Inventory, Parts A and B of the Trail Making Test, eight trials from the Rey Auditory Verbal Learning Test (RAVLT), and the Stroop test. Results:Patients who maintained paroxysmal AF for the whole study observation period (n = 10) had a significantly greater score in the sixth (A6) and seventh (A7) RAVLT trials (pertaining to parameters of long-term latent memory) at the start of the study. An association between lower RAVLT A6 and A7 trial scores and the risk of paroxysmal arrhythmia progression to permanent AF was confirmed using the Cox proportional hazards regression model and Kaplan-Meier survival analysis. Conclusions:A better long-term latent memory RAVLT score was associated with a favourable prognosis of sinus rhythm maintenance. Cognitive impairment should be investigated in patients with AF for the purpose of evaluating the patient's prognosis, subclinical injury to the cardiovascular system, and the ability to comply with treatment.

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“…4 Only recently the relation between AF and cognitive impairment has become the object of investigations, reviews, and meta-analyses. [5][6][7][8][9][10][11] The Figure schematically depicts the possible mechanisms explaining the association. Beyond its well-known effect on stroke, AF may increase dementia risk through mechanisms, such as cerebral hypoperfusion or thromboembolism, causing silent cerebral infarction.…”

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confidence: 99%

“…8 The risk was highest in patients with stroke (relative risk, 2.70; 95% CI, 1.82-4.00), but still remained significant in the broader population, including patients with or without a history of stroke (relative risk, 1.40; 95% CI, 1.19-1.64), as well as in the analysis restricted to studies that specifically assessed only patients without stroke (relative risk, 1.37; 95% CI, 1.08-1.73). 8 Recent reports from the Cardiovascular Health Study confirmed the effect of incident AF on cognitive decline.…”

mentioning

confidence: 99%

“…6 Similar results have also been confirmed in a subsequent meta-analysis in which AF was associated with a >2-fold increase in the risk of cognitive impairment or dementia after stroke (relative risk, 2.70; 95% CI, 1.82-4.00). 8 Because dementia and cognitive decline are disabling consequences of stroke, and AF is one of stroke main causes, it is intuitive to perceive the link between the 2 conditions. The term poststroke dementia has been coined to indicate all dementia syndromes occurring in time relation with a stroke.…”

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confidence: 99%

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