Atrial Fibrillation and Dementia: A Report From the AF-SCREEN International Collaboration-Reference-Cited by-同舟云学术

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

Published:2022-02 Issue:5 Volume:145 Page:392-409
ISSN:0009-7322
Container-title:Circulation
language:en
Short-container-title:Circulation

Author:

Rivard Léna¹^ORCID,Friberg Leif²^ORCID,Conen David³^ORCID,Healey Jeffrey S.³^ORCID,Berge Trygve⁴^ORCID,Boriani Giuseppe⁵^ORCID,Brandes Axel⁶^ORCID,Calkins Hugh⁷^ORCID,Camm A. John⁸^ORCID,Yee Chen Lin⁹^ORCID,Lluis Clua Espuny Josep¹⁰^ORCID,Collins Ronan¹¹,Connolly Stuart³,Dagres Nikolaos¹²^ORCID,Elkind Mitchell S.V.¹³^ORCID,Engdahl Johan¹⁴,Field Thalia S.¹⁵^ORCID,Gersh Bernard J.¹⁶^ORCID,Glotzer Taya V.¹⁷,Hankey Graeme J.¹⁸^ORCID,Harbison Joseph A.¹⁹^ORCID,Georg Haeusler Karl²⁰^ORCID,Hills Mellanie T.²¹^ORCID,Johnson Linda S.B.²²^ORCID,Joung Boyoung²³,Khairy Paul¹^ORCID,Kirchhof Paulus²⁴²⁵²⁶^ORCID,Krieger Derk²⁷,Lip Gregory Y.H.²⁸^ORCID,Løchen Maja-Lisa²⁹,Madhavan Malini³⁰,Mairesse Georges H.³¹,Montaner Joan³²³³³⁴³⁵^ORCID,Ntaios George³⁶^ORCID,Quinn Terence J.³⁷^ORCID,Rienstra Michiel²³⁸^ORCID,Rosenqvist Mårten,Sandhu Roopinder K.³⁹,Smyth Breda⁴⁰,Schnabel Renate B.⁴¹^ORCID,Stavrakis Stavros⁴²^ORCID,Themistoclakis Sakis⁴³^ORCID,Van Gelder Isabelle C.³⁸,Wang Ji-Guang⁴⁴^ORCID,Freedman Ben⁴⁵^ORCID

Affiliation:

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. Heart Research Institute for Charles Perkins Centre Heart Research Institute, and Concord Hospital Cardiology, the University of Sydney, Australia (B.F.).

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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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