The Role of Cardiovascular and Metabolic Comorbidities in the Link between Atrial Fibrillation and Cognitive Impairment: An Appraisal of Current Scientific Evidence

Abstract

Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice with implications on long-term outcomes. Metabolic disorders including diabetes mellitus and obesity are independent predictors of atrial fibrillation and present therapeutic targets to reduce both the incidence and duration burden of atrial fibrillation. The presence of pericardial fat in direct contact with cardiac structures, as well the subsequent release of proinflammatory cytokines, may play an important role in this connection. Atrial fibrillation is an independent predictor of cognitive impairment and dementia. While clinical stroke is a major contributor, other factors such as cerebral hypoperfusion and microbleeds play important roles. New evidence suggests that atrial fibrillation and cognitive impairment may be downstream events of atrial cardiomyopathy, which may be caused by several factors including metabolic syndrome, obesity, and obstructive sleep apnea. The mechanisms linking these comorbidities to cognitive impairment are not yet fully elucidated. A clearer understanding of the association of AF with dementia and cognitive impairment is imperative. Future studies should focus on the predictors of cognitive impairment among those with AF and aim to understand the potential mechanisms underlying these associations. This would inform strategies for the management of AF aiming to prevent continued cognitive impairment.

Nursing Teleconsultation for the Outpatient Management of Patients with Cardiovascular Disease during COVID-19 Pandemic

“…These data confirm that the pre-specified follow-up schedule for patients in anticoagulant therapy should not be lost during the COVID-19 pandemic, in particular for frail, elderly people with high cardiovascular risk and prevalent comorbidities, such as dyslipidemia and ischemic heart disease. Although NOACs are safer than VKAs in some different clinical settings [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ], an inappropriate dose may predispose to both hemorrhagic and thrombotic events; moreover, the use of any anticoagulant is associated with some drug–drug interactions, which may increase the risk of serious bleeding or diminish stroke protection. The teleconsultation should be oriented to evaluate the blood sampling (including hemoglobin, renal, and liver function); to check the adherence; and to re-assess if the chosen NOAC or its dose is the best for the patient, according to age, weight, or renal function [ 31 , 32 , 33 ].…”

Importance of Retesting for the Final Diagnosis of Post-Stroke Cognitive Impairment

“…Based on the current literature, CogI after a stroke is associated with cardiovascular risk factors, such as arterial hypertension, diabetes mellitus, hyperlipidaemia, atrial fibrillation, valvular defects, and thrombophilic/procoagulant states [ 11 , 23 , 24 , 25 ]. In 2020, the Lancet Commission reviewed 12 lifelong risk factors (from early school age/period through adulthood to old age) that influence the development of CogI early after a stroke.…”

Atrial Cardiomyopathy: An Unexplored Limb of Virchow's Triad for AF Stroke Prophylaxis

“…The relationship between AF and dementia has long been established (70). However, recent insights have demonstrated that there may also be an association between AC and dementia (71). For example, in a subgroup analysis of the Atherosclerosis Risk in Communities Study (ARIC) O'Neal et al demonstrated that advanced intra-atrial block on ECG, a strong indicator of left atrial remodeling present in AC, is associated with increased stroke risk and dementia risk (72).…”