Atrial Fibrillation and Dementia: A Report From the AF-SCREEN International Collaboration

Léna Rivard; Leif Friberg; David Conen; Jeffrey S Healey; Trygve Berge; Giuseppe Boriani; Axel Brandes; Hugh Calkins; A John Camm; Lin Yee Chen; Josep Lluis Clua Espuny; Ronan Collins; Stuart Connolly; Nikolaos Dagres; Mitchell S V Elkind; Johan Engdahl; Thalia S Field; Bernard J Gersh; Taya V Glotzer; Graeme J Hankey; Joseph A Harbison; Karl G Haeusler; Mellanie T Hills; Linda S B Johnson; Boyoung Joung; Paul Khairy; Paulus Kirchhof; Derk Krieger; Gregory Y H Lip; Maja-Lisa Løchen; Malini Madhavan; Georges H Mairesse; Joan Montaner; George Ntaios; Terence J Quinn; Michiel Rienstra; Mårten Rosenqvist; Roopinder K Sandhu; Breda Smyth; Renate B Schnabel; Stavros Stavrakis; Sakis Themistoclakis; Isabelle C Van Gelder; Ji-Guang Wang; Ben Freedman

doi:10.1161/CIRCULATIONAHA.121.055018

Atrial Fibrillation and Dementia: A Report From the AF-SCREEN International Collaboration

Circulation. 2022 Feb;145(5):392-409. doi: 10.1161/CIRCULATIONAHA.121.055018. Epub 2022 Jan 31.

Authors

Léna Rivard¹, Leif Friberg², David Conen³, Jeffrey S Healey³, Trygve Berge⁴, Giuseppe Boriani⁵, Axel Brandes⁶, Hugh Calkins⁷, A John Camm⁸, Lin Yee Chen⁹, Josep Lluis Clua Espuny¹⁰, Ronan Collins¹¹, Stuart Connolly³, Nikolaos Dagres¹², Mitchell S V Elkind¹³, Johan Engdahl¹⁴, Thalia S Field¹⁵, Bernard J Gersh¹⁶, Taya V Glotzer¹⁷, Graeme J Hankey¹⁸, Joseph A Harbison¹⁹, Karl G Haeusler²⁰, Mellanie T Hills²¹, Linda S B Johnson²², Boyoung Joung²³, Paul Khairy¹, Paulus Kirchhof^{24

25

26}, Derk Krieger²⁷, Gregory Y H Lip²⁸, Maja-Lisa Løchen²⁹, Malini Madhavan³⁰, Georges H Mairesse³¹, Joan Montaner^{32

33

34

35}, George Ntaios³⁶, Terence J Quinn³⁷, Michiel Rienstra^{2

38}, Mårten Rosenqvist, Roopinder K Sandhu³⁹, Breda Smyth⁴⁰, Renate B Schnabel⁴¹, Stavros Stavrakis⁴², Sakis Themistoclakis⁴³, Isabelle C Van Gelder³⁸, Ji-Guang Wang⁴⁴, Ben Freedman⁴⁵

Affiliations

¹ Montreal Heart Institute, Université de Montréal, Canada (L.R., P. Khairy).
² Karolinska Institute, Stockholm, Sweden (L.F., M.R.).
³ Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.C., J.S.H., S.C.).
⁴ Vestre Viken Hospital Trust, Norway (T.B.).
⁵ Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Italy (G.B.).
⁶ Odense University Hospital, Denmark (A.B.).
⁷ Johns Hopkins University, Baltimore, MD (H.C.).
⁸ Cardiovascular Clinical Academic Group, St Georges Hospital, London, UK (A.J.C.).
⁹ University of Minnesota, Minneapolis (L.Y.C.).
¹⁰ Catalonian Health Institute, Spain (J.L.C.E.).
¹¹ Tallaght Hospital, Dublin, Ireland (R.C.).
¹² Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Germany (N.D.).
¹³ Columbia University, New York (M.S.V.E.).
¹⁴ Karolinska Institutet, Department of Clinical Sciences, Danderyds Hospital, Stockholm, Sweden (J.E.).
¹⁵ University of British Columbia, Vancouver Stroke Program, Canada (T.S.F.).
¹⁶ Mayo Clinic, Rochester, MN (B.J.G.).
¹⁷ Hackensack University Medical Centre, NJ (T.V.G.).
¹⁸ Medical School, Faculty of Health and Medical Sciences, The University of Western Australia (G.J.H.).
¹⁹ Trinity College, Dublin, Ireland (J.H.).
²⁰ Department of Neurology, Universitätsklinikum Würzburg, Germany (K.G.H.).
²¹ StopAfib.org, Decatur, TX (M.T.H.).
²² Lund University, Sweden (L.J.).
²³ Yonsei University College of Medicine, Seoul, South Korea (B.J.).
²⁴ University Heart and Vascular Center UKE Hamburg, Germany (P. Kirchhof).
²⁵ German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany (P. Kirchhof).
²⁶ Institute of Cardiovascular Sciences, University of Birmingham, UK, and AFNET, Münster, Germany (P. Kirchhof).
²⁷ University Hospital of Zurich, Switzerland (D.K.).
²⁸ Aalborg University, Denmark (G.Y.H.L.).
²⁹ Department of Community Medicine, UiT The Arctic University of Norway, Tromsø (M.L.L.).
³⁰ Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.M.).
³¹ Cliniques du Sud Luxembourg, Arlon, Belgium (G.H.M.).
³² Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain (J.M.).
³³ Stroke Research Program, Institute of Biomedicine of Seville, Spain (J.M.).
³⁴ IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Spain (J.M.).
³⁵ Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain (J.M.).
³⁶ University of Thessaly, Greece (G.N.).
³⁷ University of Glasgow, Glasgow Royal Infirmary, UK (T.J.Q.).
³⁸ University of Groningen, University Medical Center Groningen, the Netherlands (M.R., I.C.V.G.).
³⁹ Cedars-Sinai, Los Angeles, CA (R.K.S.).
⁴⁰ Department of Public Health, Health Service Executive West, Galway, Ireland (B.S.).
⁴¹ University Heart Centre, Hamburg, Germany (R.B.S.).
⁴² University of Oklahoma Health Sciences Center, Oklahoma City (S.S.).
⁴³ Ospedale dell'Angelo Venice-Mestre, Venice, Italy (S.T.).
⁴⁴ Jiaotong University School of Medicine, China (J.G.W.).
⁴⁵ Charles Perkins Centre and Concord Hospital Cardiology, University of Sydney, Australia (B.F.).

PMID: 35100023
DOI: 10.1161/CIRCULATIONAHA.121.055018

Abstract

Growing evidence suggests a consistent association between atrial fibrillation (AF) and cognitive impairment and dementia that is independent of clinical stroke. This report from the AF-SCREEN International Collaboration summarizes the evidence linking AF to cognitive impairment and dementia. It provides guidance on the investigation and management of dementia in patients with AF on the basis of best available evidence. The document also addresses suspected pathophysiologic mechanisms and identifies knowledge gaps for future research. Whereas AF and dementia share numerous risk factors, the association appears to be independent of these variables. Nevertheless, the evidence remains inconclusive regarding a direct causal effect. Several pathophysiologic mechanisms have been proposed, some of which are potentially amenable to early intervention, including cerebral microinfarction, AF-related cerebral hypoperfusion, inflammation, microhemorrhage, brain atrophy, and systemic atherosclerotic vascular disease. The mitigating role of oral anticoagulation in specific subgroups (eg, low stroke risk, short duration or silent AF, after successful AF ablation, or atrial cardiopathy) and the effect of rhythm versus rate control strategies remain unknown. Likewise, screening for AF (in cognitively normal or cognitively impaired patients) and screening for cognitive impairment in patients with AF are debated. The pathophysiology of dementia and therapeutic strategies to reduce cognitive impairment warrant further investigation in individuals with AF. Cognition should be evaluated in future AF studies and integrated with patient-specific outcome priorities and patient preferences. Further large-scale prospective studies and randomized trials are needed to establish whether AF is a risk factor for cognitive impairment, to investigate strategies to prevent dementia, and to determine whether screening for unknown AF followed by targeted therapy might prevent or reduce cognitive impairment and dementia.

Keywords: atrial fibrillation; cognitive dysfunction; dementia.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Atrial Fibrillation / physiopathology*
Dementia / physiopathology*
Humans
Risk Factors

Abstract

Publication types

MeSH terms

Grants and funding