Atrial fibrillation as a risk factor of cognitive impairment. Review

Atrial fibrillation (AF) and cognitive impairment (CI) are now common problems, especially among the elderly. Numerous studies in recent years demonstrated the relationship between AF and CI, including dementia. Given the increasing prevalence of AF with age and aging, the number of people with CI is prognosed to increase. Leading pathogenetic factors that play a role in the development of CI in AF include focal lesions (macro‑ and microinfarctions, microhemorrhages), cerebral hypoperfusion and systemic inflammatory response. Asymptomatic (hidden, or «silent») cerebral infarcts, which are an accidental finding during neuroimaging, are more common than manifest cerebral strokes and are associated with CI. In patients with AF they are found more often than in people without AF, so, according to many researchers, AF is a significant factor in their occurrence. It should be emphasized that CI, dementia and brain aging can be prevented. Healthy lifestyles (special attention to a healthy diet, adequate physical activity and normal body weight) and proper treatment of vascular risk factors such as hypertension, diabetes mellitus, hypercholesterolemia and AF are of the utmost importance for maintaining healthy brain. Recent studies have shown the advantage of direct oral anticoagulants over warfarin in preventing the development of CD in patients with AF. Promising areas of research are the study of new (including genetic) biomarkers of high risk of KR, comparison of direct oral anticoagulants to determine optimal prevention of KR, increase patient adherence to therapy, the use of non‑pharmacological strategies to maintain sinus rhythm.