Dementia and Atrial Fibrillation: Pathophysiological Mechanisms and Therapeutic Implications
Atrial fibrillation increases the risk of stroke by a factor of four- to fivefold, and dementia is a common consequence of stroke. However, atrial fibrillation has been associated with cognitive impairment and dementia, even in patients without prior overt stroke. Nonischemic mechanisms include cere...
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| Vydáno v: | The American journal of medicine Ročník 131; číslo 12; s. 1408 |
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| Hlavní autoři: | , , , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
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United States
01.12.2018
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| ISSN: | 1555-7162, 1555-7162 |
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| Abstract | Atrial fibrillation increases the risk of stroke by a factor of four- to fivefold, and dementia is a common consequence of stroke. However, atrial fibrillation has been associated with cognitive impairment and dementia, even in patients without prior overt stroke. Nonischemic mechanisms include cerebral hypoperfusion, vascular inflammation, brain atrophy, genetic factors, and shared risk factors such as age or hypertension. Critical appraisal of studies evaluating the association between atrial fibrillation and dementia in stroke-free patients reveals that several suffer from methodological issues, such as not including silent stroke or anticoagulation therapy in multivariate analyses. Some studies show a close relationship between atrial fibrillation and dementia due to silent stroke, in the absence of overt stroke. Evidence is accumulating that anticoagulation may be effective to decrease the risk of dementia in atrial fibrillation patients. Overall, the pathogenesis linking atrial fibrillation to dementia is likely multifactorial. Cerebral infarctions, including silent stroke, play a central role. These findings underscore the importance of stroke prevention measures in atrial fibrillation patients. |
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| AbstractList | Atrial fibrillation increases the risk of stroke by a factor of four- to fivefold, and dementia is a common consequence of stroke. However, atrial fibrillation has been associated with cognitive impairment and dementia, even in patients without prior overt stroke. Nonischemic mechanisms include cerebral hypoperfusion, vascular inflammation, brain atrophy, genetic factors, and shared risk factors such as age or hypertension. Critical appraisal of studies evaluating the association between atrial fibrillation and dementia in stroke-free patients reveals that several suffer from methodological issues, such as not including silent stroke or anticoagulation therapy in multivariate analyses. Some studies show a close relationship between atrial fibrillation and dementia due to silent stroke, in the absence of overt stroke. Evidence is accumulating that anticoagulation may be effective to decrease the risk of dementia in atrial fibrillation patients. Overall, the pathogenesis linking atrial fibrillation to dementia is likely multifactorial. Cerebral infarctions, including silent stroke, play a central role. These findings underscore the importance of stroke prevention measures in atrial fibrillation patients.Atrial fibrillation increases the risk of stroke by a factor of four- to fivefold, and dementia is a common consequence of stroke. However, atrial fibrillation has been associated with cognitive impairment and dementia, even in patients without prior overt stroke. Nonischemic mechanisms include cerebral hypoperfusion, vascular inflammation, brain atrophy, genetic factors, and shared risk factors such as age or hypertension. Critical appraisal of studies evaluating the association between atrial fibrillation and dementia in stroke-free patients reveals that several suffer from methodological issues, such as not including silent stroke or anticoagulation therapy in multivariate analyses. Some studies show a close relationship between atrial fibrillation and dementia due to silent stroke, in the absence of overt stroke. Evidence is accumulating that anticoagulation may be effective to decrease the risk of dementia in atrial fibrillation patients. Overall, the pathogenesis linking atrial fibrillation to dementia is likely multifactorial. Cerebral infarctions, including silent stroke, play a central role. These findings underscore the importance of stroke prevention measures in atrial fibrillation patients. Atrial fibrillation increases the risk of stroke by a factor of four- to fivefold, and dementia is a common consequence of stroke. However, atrial fibrillation has been associated with cognitive impairment and dementia, even in patients without prior overt stroke. Nonischemic mechanisms include cerebral hypoperfusion, vascular inflammation, brain atrophy, genetic factors, and shared risk factors such as age or hypertension. Critical appraisal of studies evaluating the association between atrial fibrillation and dementia in stroke-free patients reveals that several suffer from methodological issues, such as not including silent stroke or anticoagulation therapy in multivariate analyses. Some studies show a close relationship between atrial fibrillation and dementia due to silent stroke, in the absence of overt stroke. Evidence is accumulating that anticoagulation may be effective to decrease the risk of dementia in atrial fibrillation patients. Overall, the pathogenesis linking atrial fibrillation to dementia is likely multifactorial. Cerebral infarctions, including silent stroke, play a central role. These findings underscore the importance of stroke prevention measures in atrial fibrillation patients. |
| Author | Goldhaber, Samuel Z Kim, Jisoo Albertsen, Ida Ehlers Chopard, Romain Gale, Seth Alan Campia, Umberto Piazza, Gregory |
| Author_xml | – sequence: 1 givenname: Romain surname: Chopard fullname: Chopard, Romain email: chopardromain@yahoo.fr organization: Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital; Harvard Medical School. Electronic address: chopardromain@yahoo.fr – sequence: 2 givenname: Gregory surname: Piazza fullname: Piazza, Gregory organization: Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital; Harvard Medical School – sequence: 3 givenname: Seth Alan surname: Gale fullname: Gale, Seth Alan organization: Department of Neurology, Center for Brain/Mind Medicine, Brigham and Women's Hospital, Boston, Mass – sequence: 4 givenname: Umberto surname: Campia fullname: Campia, Umberto organization: Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital; Harvard Medical School – sequence: 5 givenname: Ida Ehlers surname: Albertsen fullname: Albertsen, Ida Ehlers organization: Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital; Harvard Medical School; Department of Cardiology, Aalborg University Hospital; Aalborg Thrombosis Research Unit, Aalborg University, Denmark – sequence: 6 givenname: Jisoo surname: Kim fullname: Kim, Jisoo organization: Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital; Department of Radiology, Brigham and Women's Hospital, Boston, Mass – sequence: 7 givenname: Samuel Z surname: Goldhaber fullname: Goldhaber, Samuel Z organization: Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital; Harvard Medical School |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/30076825$$D View this record in MEDLINE/PubMed |
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| Keywords | Stroke Anticoagulation Atrial fibrillation Dementia |
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| SubjectTerms | Anticoagulants - therapeutic use Atrial Fibrillation - complications Atrial Fibrillation - drug therapy Dementia - complications Humans Risk Factors |
| Title | Dementia and Atrial Fibrillation: Pathophysiological Mechanisms and Therapeutic Implications |
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