Cognitive Function in Atrial Fibrillation: A Narrative Review of Evidence and Mechanisms

Abstract

Atrial fibrillation (AF) is associated with cognitive impairment, with or without history of stroke. The risk of developing cognitive impairment is increased after clinical stroke. Prospective registries confirm the increased risk of both vascular and Alzheimer’s dementia in patients with AF. The purported mechanistic links between AF and cognitive impairment are clinical stroke, subclinical cerebral small-vessel disease, autonomic dysfunction, and systemic and neuroinflammation. Several shared risk factors and genetics also contribute to this interplay. In this review, we explore the evidence bridging cognitive impairment with AF and review the mechanisms and therapeutic targets.