Atrial fibrillation and risk of cognitive impairment and dementia: Relationships, potential mechanisms, and current therapies

Atrial fibrillation (AF), cognitive impairment, and dementia are significant health concerns. The prevalence and incidence of AF have been increasing and are expected to increase continuously in the future. In recent years, emerging evidence has indicated that AF, cognitive dysfunction, and dementia are associated with one another. Given the global increase in individuals who are at risk for AF, a greater focus is needed on the primary and secondary prevention of cognitive impairment and dementia in high-risk groups. Although earlier studies hypothesized that ischemic stroke is the main cause of cognitive impairment and dementia in patients with AF, recent studies have demonstrated that AF may contribute to cognitive impairment in the absence of stroke through other mechanisms. To date, various pathomechanisms have been proposed to explain the association between AF and cognitive decline, including overt ischemic stroke, silent cerebral infarctions, impaired cerebrovascular reactivity, decreased cerebral blood perfusion, neuroinflammation, microbleeds, and shared risk factors. However, a complete understanding of these mechanisms remains elusive. In addition, whether treatments targeting AF, including anticoagulation and rhythm control strategies, can avert cognitive decline and dementia has great clinical implications. To pave the way for targeted effective interventions for cognitive protection, we provide an overview of the association between AF and cognitive impairment and the potential mechanisms underlying this association. In addition, the effectiveness of AF-related treatment strategies, including anticoagulation, sinus rhythm restoration through elective cardioversion and catheter ablation, for cognitive protection in patients with AF is also discussed in this review.