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Cognitive decline pursuant to atrial fibrillation

Krzysztof M. Wilczyński1, Dominika Wizner-Wilczyńska1, Ewa Martyniak2, Marek Krzystanek2
Affiliacja i adres do korespondencji
Psychiatr Psychol Klin 2017, 17 (3), p. 183–188
DOI: 10.15557/PiPK.2017.0021
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Introduction: The influence of atrial fibrillation on the development of cognitive deficits, which are subtle, yet burdensome for the patients, and are independent of hypertension and past strokes, has been widely discussed in literature. The aim of our study was to review the available publications concerning the pathogenesis and epidemiology of cognitive decline pursuant to atrial fibrillation. Methodology: A systematic review of literature published between January 2006 and December 2016 has been conducted, utilising PubMed, Cochrane Library and Google Scholar search engines. Thirty-two out of 633 Polish and English publications were ultimately covered by the study, along with 8 out of 16 reference included in the analysed papers. Results: The majority of authors agree that the link between atrial fibrillation and cognitive decline and occurrence of dementia is undisputable. The high risk for the occurrence of a stroke in the course of atrial fibrillation, which is twice the risk found in healthy persons, seems to be the most plausible explanation for the aforementioned correlation. However, in most studies the exclusion of patients with a history of stroke did not significantly affect the risk for cognitive decline. In some studies, a decrease in the volume of some central nervous system structures was also reported, especially affecting the hippocampus, yet the results remain equivocal. Some authors describe a link between decreased blood flow in the middle cerebral artery in elderly patients and the occurrence of cognitive impairment. This mechanism, however, was analysed in relatively small groups, with a high mean age of the included patients. The most recent studies focus on hypotheses concerning abnormalities in cytokine levels, although significant differences in the methodology utilised in those analyses have not permitted to identify their role in the process. Conclusions: Despite the apparently undisputable link between atrial fibrillation and cognitive decline, the underlying mechanism remains unclear. Hence the need for further research in this area, aimed at determining the specific pathomechanism reliable for the association of these two phenomena.

Słowa kluczowe
atrial fibrillation, cognitive decline/cognitive impairment, epidemiology, pathophysiology