Cognitive impairment in patients with atrial fibrillation
DOI: 10.32364/2587-6821-2020-4-9-578-583
E.V. Mityaeva1, P.R. Kamchatnov2
1Orel State University named after I.S. Turgenev, Orel, Russian Federation
2Pirogov Russian National Research Medical University, Moscow, Russian Federation
Atrial fibrillation (AF) is an important medical and social problem due to its wide prevalence in the population and high risk of embolic complications leading to severe consequences. The article describes an association established between AF and an increased risk of cognitive impairment (CI). Cardioembolic stroke due to AF is a common cause of CI, however, there are other mechanisms for CI development. The article also examines the role of small vessel disease and asymptomatic cerebral infarction in the formation of CI in patients with AF. Adding that, it provides data on the AF role in the development of neurodegenerative process with the accumulation of amyloid and tau protein in the brain tissue. There is an increased risk of Alzheimer’s disease in patients with AF, although the causal relationship of these conditions requires clarification. Modern data concerning the role of neuroinflammation and genetic predisposition in the development of CI in AF were analyzed. The conclusion is made about the pathogenetic heterogeneity of higher cerebral functions disorders on the basis of the presented data on the CI pathogenetic mechanism in patients with AF and comorbid conditions. It was suggested that the optimal pathogenetic therapy can be chosen taking into account the known CI pathogenetic mechanisms.
Keywords: atrial fibrillation, cognitive impairment, dementia, Alzheimer’s disease, cardioembolic stroke, small vessel disease, neurodegeneration, amyloid, tau protein, pathogenesis.
For citation: Mityaeva E.V., Kamchatnov P.R. Cognitive impairment in patients with atrial fibrillation. Russian Medical Inquiry. 2020;4(9):578–583. DOI: 10.32364/2587-6821-2020-4-9-578-583.
About the authors:
Elena V. Mityaeva — postgraduate student of the Department of Psychiatry and Neurology of the Faculty of General Medicine, Orel State University named after I.S. Turgenev: 95, Komsomolskaya str., Orel, 302026, Russian Federation; ORCID iD 0000-0001-9964-7549.
Pavel R. Kamchatnov — Dr. of Sci. (Med.), Professor of the Department of Neurology, Neurosurgery and Medical Genetics, Faculty of General Medicine, Pirogov Russian National Research Medical University: 1, Ostrovityanova str., Moscow, 117997, Russian Federation; ORCID iD 0000-0001-6747-3476.
Contact information: Pavel R. Kamchatnov, e-mail: pavkam7@gmail.com. Financial Disclosure: no authors have a financial or property interest in any material or method mentioned. There is no conflict of interests. Received 18.09.2020, revised 02.10.2020, accepted 16.10.2020.
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13. Banerjee G., Chan E., Ambler G. et al. Effect of small-vessel disease on cognitive trajectory after atrial fibrillation-related ischaemic stroke or TIA. J Neurol. 2019;266(5):1250–1259. DOI: 10.1007/s00415-019-09256-6.
14. Banerjee G., Chan E., Ambler G. et al. Cognitive impairment before atrial fibrillation-related ischemic events: neuroimaging and prognostic associations. J Am Heart Assoc. 2020;9(1):e014537. DOI: 10.1161/JAHA.119.014537.
15. Best J.G., Barbato C., Ambler G. et al. Association of enlarged perivascular spaces and anticoagulant-related intracranial hemorrhage. Neurology. 2020;95(16):e2192–e2199. DOI: 10.1212/WNL.0000000000010788.
16. Song T., Kim J., Lee H. et al. The frequency of cerebral microbleeds increases with CHADS scores in stroke patients with non-valvular atrial fibrillation. Eur J Neurol. 2013;20:502–508. DOI: 10.1111/ene.12003.
17. Enciu A., Constantinescu S., Popescu L. et al. Neurobiology of vascular dementia. J Aging Res. 2011;2011:401604. DOI: 10.4061/2011/401604.
18. Gardarsdottir M., Sigurdsson S., Aspelund T. et al. Atrial fibrillation is associated with decreased total cerebral blood flow and brain perfusion. Europace. 2018;20(8):1252–1258. DOI: 10.1093/europace/eux220.
19. Hashimoto H., Nakanishi R., Mizumura S. et al. Prognostic value of 99m Tc-ECD brain perfusion SPECT in patients with atrial fibrillation and dementia. EJNMMI Res. 2020;10(1):3. DOI: 10.1186/s13550-019-0589-3.
20. Alosco M., Spitznagel M., Sweet L. et al. Atrial fibrillation exacerbates cognitive dysfunction and cerebral perfusion in heart failure. Pacing Clin Electrophysiol. 2015;38:178–186. DOI: 10.1111/pace.12543.
21. Пышкина Л.И., Абиева А.Р., Камчатнов П.Р. и др. Течение цереброваскулярной патологии у больных со стенозирующим поражением сонных артерий. Журнал неврологии и психиатрии им. С.С. Корсакова. 2018;9(2):24–29. DOI: 10.17116/jneuro20181180928. [Pyshkina L.I., Abieva A.R., Kamchatnov P.R. et al. The course of cerebrovascular pathology in patients with carotid artery stenosis. S.S. Korsakov Journal of Neurology and Psychiatry. 2018;9(2):24–29 (in Russ.)]. DOI: 10.17116/jneuro20181180928.
22. Cacciatore F., Testa G., Langellotto A. et al. Role of ventricular rate response on dementia in cognitively impaired elderly subjects with atrial fibrillation: a 10-year study. Dement Geriatr Cogn Disord. 2012;34:143–148. DOI: 10.1159/000342195.
23. Jefferson A.L., Liu D., Gupta D.K. et al. Lower cardiac index levels relate to lower cerebral blood flow in older adults. Neurology. 2017;89:2327–2334. DOI: 10.1212/WNL.0000000000004707.
24. Жетишев Р.Р., Михайлова Н.А., Камчатнов П.Р., Иващенко Р.А. Клиническое значение асимптомных инфарктов при цереброваскулярных заболеваниях и их связь с когнитивными нарушениями. Неврологический вестник. 2014;44;2:8–12. DOI: 10.17816/nb13832. [Zhetishev R.R., Mikhailova N.A., Kamchatnov P.R., Ivashchenko R.A. Clinical significance of asymptomatic heart attacks in cerebrovascular diseases and their relationship with cognitive disorders. Neurological Bulletin. 2014;44;2:8–12 (in Russ.)]. DOI: 10.17816/nb13832.
25. Conen D., Rodondi N., Müller A. et al. Relationships of Overt and Silent Brain Lesions With Cognitive Function in Patients With Atrial Fibrillation. J Am Coll Cardiol. 2019;73(9):56–62. DOI: 10.1016/j.jacc.2018.12.039.
26. Vermeer S., Prins N., den Heijer T. et al. Silent brain infarcts and the risk of dementia and cognitive decline. N Engl J Med. 2003;348:1215–1222. DOI: 10.1056/NEJMoa022066.
27. Sugioka K., Takagi M., Sakamoto S. et al. Predictors of silent brain infarction on magnetic resonance imaging in patients with nonvalvular atrial fibrillation: A transesophageal echocardiographic study. Am Heart J. 2015;169:783–790. DOI: 10.1016/j.ahj.2015.03.016.
28. Martin D., Bersohn M., Waldo A. et al. Randomized trial of atrial arrhythmia monitoring to guide anticoagulation in patients with implanted defibrillator and cardiac resynchronization devices. Eur Heart J. 2015;36:1660–1665. DOI: 10.1093/eurheartj/ehv115.
29. Brambatti M., Connolly S., Gold M. et al. Temporal relationship between subclinical atrial fibrillation and embolic events. Circulation. 2014;129:2094–2099. DOI: 10.1161/CIRCULATIONAHA.113.007825.
30. Conway D., Buggins P., Hughes E., Lip G. Prognostic significance of raised plasma levels of interleukin-6 and C-reactive protein in atrial fibrillation. Am Heart J. 2004;148:462–466. DOI: 10.1016/j.ahj.2004.01.026.
31. De Luca S., Miller A., Sominsky L., Spencer S. Microglial regulation of satiety and cognition. J Neuroendocrinol. 2020;32(3):e12838. DOI: 10.1111/jne.12838.
32. Tan Z., Rastas Beiser A., Vasan R. et al. Inflammatory markers and the risk of Alzheimer disease: the Framingham Study. Neurology. 2007;68:1902–1908. DOI: 10.1212/01.wnl.0000263217.36439.da.
33. Grammas P. Neurovascular dysfunction, inflammation and endothelial activation: implications for the pathogenesis of Alzheimer’s disease. J Neuroinflammation. 2011;8:26. DOI: 10.1186/1742-2094-8-26.
34. Gellersen H., Guo C., O’Callaghan C. et al. Cerebellar atrophy in neurodegeneration a meta-analysis. J Neurol Neurosurg Psychiatry. 2017;88:780–788. DOI: 10.1136/jnnp-2017-315607.
35. Stefansdottir H., Arnar D., Aspelund T. et al. Atrial fibrillation is associated with reduced brain volume and cognitive function independent of cerebral infarcts. Stroke. 2013;44:1020–1025. DOI: 10.1161/STROKEAHA.12.679381.
36. Piers R., Nishtala A., Preis S. et al. Association between atrial fibrillation and volumetric magnetic resonance imaging brain measures: Framingham Offspring Study. Heart Rhythm. 2016;13:2020–2024. DOI: 10.10116/j.hrthm.2016.07.004.
37. Knecht S., Oelschlager C., Duning T. et al. Atrial fibrillation in strokefree patients is associated with memory impairment and hippocampal atrophy. Eur Heart J. 2008;29:2125–2132. DOI: 10.1093/eurheartj/ehn341.
38. Dolek N., Saylisoy S., Ozbabalik D., Adapinar B. Comparison of hippocampal volume measured using magnetic resonance imaging in Alzheimer’s disease, vascular dementia, mild cognitive impairment and pseudodementia. J Int Med Res. 2012;40:717–725. DOI: 10.1177/147323001204000236.
39. Nyberg J., Åberg M., Schiöler L. et al. Cardiovascular and cognitive fitness at age 18 and risk of early-onset dementia. Brain. 2014;137(Pt 5):1514–1523. DOI: 10.1093/brain/awu041.
40. Sposato L.A., Ruiz Vargas E., Riccio P.M. et al. Milder Alzheimer’s disease pathology in heart failure and atrial fibrillation. Alzheimers Dement. 2017;13:770–777. DOI: 10.1016/j.jalz.2016.12.002.
41. Dublin S., Anderson M., Haneuse S. et al. Atrial fibrillation and risk of dementia: a prospective cohort study. J Am Geriatr Soc. 2011;59:1369–1375. DOI: 10.1111/j.1532-5415.2011.03508.x.
42. Ettorre E., Cicerchia M., De Benedetto G. et al. A possible role of atrial fibrillation as a risk factor for dementia. Arch Gerontol Geriatr. 2009;49:71–76. DOI: 10.1016/j.archger.2009.09.014.
43. Viswanathan A., Rocca W.A., Tzourio C. Vascular risk factors and dementia: how to move forward? Neurology. 2009;72:368–374. DOI: 10.1212/01.wnl.0000341271.90478.8e.
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