Prevention of Dementia in Patients with Atrial Fibrillation

Kim, Daehoon; Yang, Pil Sung; Joung, Boyoung

doi:10.4070/kcj.2021.0027

Cited by 7 publications

(6 citation statements)

References 60 publications

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“…Unfortunately, these drugs remain under administered in elderly patients with dementia, even in the presence of AF 43,44 . Other findings showed that more invasive treatment, such as catheter ablation, may be another optional treatment to reduce the burden of dementia in these patients, but in most of cases but it remains an invasive procedure with related risk especially in elderly subjects with serval comorbidities and a potential source of silent strokes and cognitive impairment 23,45 . From a pathophysiological perspective, dementia and AF seems to be linked by the appearance of micro embolic events as well as microinfarcts, as those observed in AD patients 24,46 .…”

Section: Discussionmentioning

confidence: 99%

“…43,44 Other findings showed that more invasive treatment, such as catheter ablation, may be another optional treatment to reduce the burden of dementia in these patients, but in most of cases but it remains an invasive procedure with related risk especially in elderly subjects with serval comorbidities and a potential source of silent strokes and cognitive impairment. 23,45 From a pathophysiological T A B L E 3 (Continued) perspective, dementia and AF seems to be linked by the appearance of micro embolic events as well as microinfarcts, as those observed in AD patients. 24,46 Proinflammatory states are actively implicated in both the genesis and perpetuation of AF, as well as in the promotion of hypercoagulability and thrombus formation, predisposing to stroke.…”

Section: Discussionmentioning

confidence: 99%

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Risk of dementia in patients with atrial fibrillation: Short versus long follow‐up. A systematic review and meta‐analysis

Zuin

Roncon

Passaro

et al. 2021

Int J Geriat Psychiatry

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Background No previous meta‐analyses have compared the risk of dementia, due to an underlying atrial fibrillation (AF), in the short‐term versus the long‐term period. Aim To perform an update meta‐analysis of studies examining the association between AF and dementia and the relative impact of follow‐up period. Methods Data were obtained searching MEDLINE and Scopus for all investigations published between 1 January 2000 and March 1, 2021 reporting the risk of dementia in AF patients. The following MeSH terms were used for the search: “Atrial Fibrillation” AND “Dementia” OR “Alzheimer’s disease”. From each study, the adjusted hazard ratio (aHR) with the related 95% confidence interval (CI) was pooled using a random effect model. Results The analysis was carried out on 18 studies involving 3.559.349 subjects, of which 902.741 (25.3%) developed dementia during follow‐up. A random effect model revealed an aHR of 1.40 (95% CI: 1.27–1.54, p < 0.0001; I2 = 93.5%) for dementia in subjects with AF. Stratifying the studies according to follow‐up duration, those having a follow‐up ≥10 years showed an aHR for dementia of 1.37 (95% CI: 1.21–1.55, p < 0.0001, I2 = 96.6%), while those with a follow‐up duration <10 years has a slightly higher aHR for dementia (HR: 1.59, 95%CI: 1.51–1.67, p < 0.0001, I2 = 49%). Nine studies showed that the aHR for Alzheimer’s disease (AD) in AF patients was 1.30 (95%CI: 1.12–1.51, p < 0.0001, I2 = 87.6%). Conclusions Evidence suggests that patients with AF have an increased risk of developing dementia and AD. The risk of dementia was slightly higher when the follow‐up was shorter than 10 years.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk of dementia in patients with atrial fibrillation: Short versus long follow‐up. A systematic review and meta‐analysis

Zuin

Roncon

Passaro

et al. 2021

Int J Geriat Psychiatry

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“… 10) Integrated AF management controlling risk factors was also shown to be associated with a lower risk of dementia. 64) 65) 66) 67) …”

Section: Rhythm Control and Prevention Of Dementiamentioning

confidence: 99%

“…The effect of rhythm control treatment for AF on cognitive outcomes has been unclear. 67) 68) A sub-analysis of the AFFIRM trial reported no difference in cognitive function between treatment strategies of rate or rhythm control. 69) However, several observational investigations have suggested that AF ablation may improve cognitive function and reduce dementia risk.…”

Section: Rhythm Control and Prevention Of Dementiamentioning

confidence: 99%

Optimal Rhythm Control Strategy in Patients With Atrial Fibrillation

2022

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Author's summary In the recent EAST-AFNET 4 trial, early rhythm control reduced the risk of adverse cardiovascular events compared with usual care in patients recently diagnosed as atrial fibrillation (AF). Recent observational studies from Korean nationwide claim data confirmed and extended the findings from controlled trials. The beneficial effect of rhythm control on cardiovascular outcomes was not obvious in those who had been diagnosed with AF more than 1 year ago. Especially, early initiation of rhythm control was related to the lower risk of stroke and hospitalization due to heart failure. Finally, early rhythm control treatment was also effective in patients with asymptomatic AF but less effective in older adults. Therefore, in patients with AF, rhythm control should be considered at the earliest stage, regardless of symptom.

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“…However, recent research has indicated that there is a high prevalence of dementia in atrial fibrillation patients independent of age and past cerebrovascular accident (CVA). 2 , 3 Even after adjusting all possible confounding variables presence of AF confers a 2-to-3-fold increased risk of developing cognitive dysfunction and dementia. 4 , 5 …”

Section: Introductionmentioning

confidence: 99%