Atrial fibrillation as a driver of cognitive decline

Traditionally, Atrial Fibrillation (AF) has been managed to reduce the risk of stroke, but there is an increasing amount of evidence to suggest that atrial fibrillation is also related to a decline in cognitive function (dementia) and not necessarily related to blood clots or interruptions to blood flow. The aim of this review is to evaluate different mechanisms contributing to the relationship between atrial fibrillation and dementia through hemodynamic and inflammatory pathways. In order to achieve this, a systematic review of longitudinal studies, randomized trials from the past five years, and neuroimaging studies (2013-2026) was conducted to examine the neurocognitive variables relative to atrial fibrillation through the PubMed and Cochrane database. The results of this study suggest that patients with atrial fibrillation are at increased risk of developing dementia independent of thromboembolic events (1.4-2.2 times). Primary risk factors affecting this relationship include silent cerebral infarcts (40% of patients will have these) and chronic cerebral hypoperfusion associated with beat-to-beat variability. Of particular note, patients with atrial fibrillation who achieve early rhythm control using catheter ablation demonstrate a 27%-30% lower risk of cognitive dysfunction as compared to those with rate control. There are numerous and complex physiological changes that can occur from atrial fibrillation that can lead to cognitive decline.