Cognitive Function and Atrial Fibrillation: From the Strength of Relationship to the Dark Side of Prevention. Is There a Contribution from Sinus Rhythm Restoration and Maintenance?

Atrial fibrillation (AF) is the most common chronic cardiac arrhythmia with an increasing prevalence over time mainly because of population aging. It is well established that the presence of AF increases the risk of stroke, heart failure, sudden death, and cardiovascular morbidity. In the last two decades several reports have shown an association between AF and cognitive function, ranging from impairment to dementia. Ischemic stroke linked to AF is a well-known risk factor and predictor of cognitive decline. In this clinical scenario, the risk of stroke might be reduced by oral anticoagulation. However, recent data suggest that AF may be a predictor of cognitive impairment and dementia also in the absence of stroke. Cerebral hypoperfusion, reduced brain volume, microbleeds, white matter hyperintensity, neuroinflammation, and genetic factors have been considered as potential mechanisms involved in the pathogenesis of AF-related cognitive dysfunction. However, a cause-effect relationship remains still controversial. Consequently, no therapeutic strategies are available to prevent AF-related cognitive decline in stroke-free patients. This review will analyze the potential mechanisms leading to cognitive dysfunction in AF patients and examine the available data on the impact of a sinus rhythm restoration and maintenance strategy in reducing the risk of cognitive decline.

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P5659Atrial fibrillation causes cognitive impairment-which cognitive domains are affected?

European Heart Journal ◽

10.1093/eurheartj/ehz746.0602 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

T Pal ◽

M German-Sallo ◽

Z Preg ◽

D Szentendrey ◽

R G Tripon ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cognitive Impairment ◽

Sinus Rhythm ◽

Cognitive Dysfunction ◽

Cognitive Functions ◽

Hungarian Academy ◽

Hypertensive Patients ◽

Cognitive Domains ◽

Increased Risk ◽

The Impact

Abstract Introduction Hypertension is an important modifiable risk factor related to cognitive dysfunction. Data suggest that atrial fibrillation (AF) is also associated with an increased risk of cognitive decline, independent of stroke history. Few studies focus on the effect of AF on specific cognitive domains. Purpose We aimed in this study to investigate the prevalence of cognitive dysfunction among hypertensive patients with atrial fibrillation and to evaluate the impact of atrial fibrillation on the affected cognitive domains. Methods In the present paper, we included 488 consecutive hypertensive patients admitted to a Cardiovascular Rehabilitation Clinic aged between 37–93 years (mean age: 68±10 years; 51.84% female; 48.15% male). Diagnosis of AF was based on 12 lead ECG. All types of AF (paroxysmal, persistent and permanent) were included. The prevalence of atrial fibrillation in our sample was 23.77% (n=116), on admission mean heart rate was 76±16 bpm and mean blood pressure 137/82 mmHg (±19/11 mmHg). After routine clinical assessment all participants completed the Montreal Cognitive Assessment (MoCA) test used for the detection of mild cognitive impairment. Depression as a confounding factor on cognitive performances was detected with the shortened 13 items form of Beck Depression Inventory (BDI-13). We compared MoCA scores of the group of patients with atrial fibrillation with scores from the group in sinus rhythm. Statistical analysis was performed with the IBM SPSS v.20 program. Results Impairment in cognitive functions was revealed among hypertensive patients in sinus rhythm vs. with atrial fibrillation according to MoCA in 66.1% (n=246) vs. 81.9% (n=95). Cognitive scores were significantly lower in the atrial fibrillation group vs. patients in sinus rhythm: MoCA: 21.74 vs. 22.97 (p=0.016). The prevalence of depression in the two groups was not statistically different, AF 52.58% vs. 55.34% patients in sinus rhythm (p=0.89). Analysing MoCA's cognitive domains, patients with atrial fibrillation had significantly lower scores in visuospatial/executive (3.09 vs. 3.52 p=0.005), language (1.59 vs. 1.85 p=0.019) and abstraction (1.18 vs. 1.41 p=0.005) domains. Conclusions The prevalence of cognitive impairment is higher in patients with atrial fibrillation. Atrial fibrillation may have an impact on the most complex cognitive functions as visuospatial/executive, language and abstraction. Acknowledgement/Funding Funding for the study was provided by the Hungarian Academy of Science, contract nr. 0346/26.02.2016.

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P178 Sinus rhythm restoration by catheter ablation improved cognitive function in elderly patients with atrial fibrillation

European Heart Journal ◽

10.1093/ehjci/ehz872.059 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

Author(s):

K Fujiyoshi ◽

M Minami ◽

D Saito ◽

T Hashimoto ◽

T Yoshizawa ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cognitive Function ◽

Catheter Ablation ◽

Elderly Patients ◽

Sinus Rhythm ◽

Mmse Score ◽

Effect Estimate ◽

Significant Difference ◽

The Impact ◽

Af Recurrence

Abstract Background Atrial fibrillation (AF) may cause cognitive impairment. However, the impact of sinus rhythm (SR) restoration by catheter ablation on the improvement of cognitive function remains to be elucidated. Methods A total of 57 consecutive elderly patients (70.8 ± 4.8 years old) who underwent catheter ablation for AF were prospectively enrolled. The change of cognitive function for 6 months was compared between patients with SR restoration (at least 3 months; n = 49) and patients with AF recurrence (n = 8). Cognitive function was evaluated by the mini-mental state examination (MMSE). Results There was no significant difference in baseline characteristics between the 2 groups, including MMSE score (27.3 ± 2.6 vs. 27.6 ± 1.5 points; p = 0.793). The change of MMSE score was significantly greater in patients with SR restoration than those with AF recurrence (0.28 ± 0.70 vs. − 0.50 ± 0.75 points; p = 0.006; Figure). The general liner modeling revealed that SR restoration (effect estimate, 0.369; 95% confidence interval, 0.110 to 0.627; p = 0.006) was independently associated with the change of MMSE score. Conclusion In elderly AF patients, successful restoration of SR by catheter ablation was associated with the improvement of cognitive function. Abstract P178 Figure

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Cognitive outcomes post-catheter ablation for atrial fibrillation: a systematic review and meta-analysis

EP Europace ◽

10.1093/europace/euab116.080 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

R Kerley ◽

H Dolphin ◽

H Cronin ◽

R Murphy ◽

R O"lionaird ◽

...

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Cognitive Function ◽

Catheter Ablation ◽

Sinus Rhythm ◽

Large Scale ◽

Meta Analysis ◽

Cognitive Outcomes ◽

Neurocognitive Outcomes ◽

The Impact

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial fibrillation (AF) is a known risk factor for cognitive impairment and dementia. Recent data suggests that successful restoration of sinus rhythm by catheter ablation improves cognitive outcomes. Purpose: Our aim was to perform a systematic review and meta-analysis of the available data regarding the effectiveness of AF catheter ablation on neurocognitive outcomes. Methods: A comprehensive literature search was performed through December 1, 2020, for all eligible studies comparing neurocognitive outcomes in AF patients with or without AF catheter ablation. Clinical outcomes included rate of dementia, cognitive function by Montreal Cognitive Assessment (MOCA) and Mini-Mental State Examination (MMSE) scores. Additional outcomes included the impact of time in sinus rhythm on neurocognitive outcomes. Results: We identified 11 studies which evaluated the effect of AF catheter ablation on dementia rate, MMSE and MOCA score. Meta-analysis of observational results indicates a decreased risk of dementia (risk ratio 0.51; 95% CI: 0.43 to 0.60; p <0.001) and an improvement in MOCA scores (2.92 points, p < 0.001) but not MMSE scores in patients undergoing AF catheter ablation compared to medical therapy. In addition, the maintenance of sinus rhythm was identified as a significant factor in dementia rate and improvement of MMSE and MOCA scores observed post catheter ablation therapy. Conclusion: AF catheter ablation may reduce the incidence of dementia and improve cognitive function. A large-scale randomized control trial is warranted before recommendations can be made regarding AF ablation and cognitive outcomes. Abstract Figure.

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Atrial Fibrillation, Cognitive Decline and Dementia

European Cardiology Review ◽

10.15420/ecr.2016:13:2 ◽

2016 ◽

Vol 11 (1) ◽

pp. 49 ◽

Cited By ~ 25

Author(s):

Alvaro Alonso ◽

Antonio P Arenas de Larriva ◽

◽

Keyword(s):

Atrial Fibrillation ◽

Cognitive Decline ◽

Observational Studies ◽

Cognitive Outcomes ◽

Cerebral Hypoperfusion ◽

Cardiovascular Risk Profile ◽

Cerebral Infarcts ◽

Community Based ◽

Increased Risk ◽

The Impact

Atrial fibrillation (AF) is a common cardiac arrhythmia. There is growing evidence that AF is a risk factor for cognitive decline and dementia. In this review, we summarise epidemiological observations linking AF with cognitive outcomes, describe potential mechanisms and explore the impact of AF treatments on cognitive decline and dementia. Community-based observational studies show a consistently higher rate of cognitive decline and increased risk of dementia in persons with AF. These associations are partly due to the increased risk of clinical stroke in AF, but other mechanisms, including the incidence of silent cerebral infarcts, microbleeds and cerebral hypoperfusion, are likely additional contributors. Adequate oral anticoagulation and improved management of the overall cardiovascular risk profile in individuals with AF offer the promise of reducing the impact of AF on cognitive decline and dementia.

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Abstract 39: Acute Blood Pressure Dysregulation Increases the Risk of Border Zone Ischemic Lesions in Hypertensive Intracerebral Hemorrhage

Stroke ◽

10.1161/str.52.suppl_1.39 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Szu-Ju Chen ◽

Hsin-Hsi Tsai ◽

Li-Kai Tsai ◽

Ya-Fang Chen ◽

Sung-Chun Tang ◽

...

Keyword(s):

Blood Pressure ◽

Intracerebral Hemorrhage ◽

Small Vessel Disease ◽

Brain Mri ◽

Border Zone ◽

Cerebral Hypoperfusion ◽

White Matter Hyperintensity ◽

Roc Curve Analysis ◽

The Difference ◽

The Impact

Background: Intensive blood pressure (BP) reduction is regarded as the gold standard therapy for acute intracerebral hemorrhage (ICH), but its associations to cerebral hypoperfusion and ischemic lesions have been suspected. This study aims to investigate the impact of acute BP reduction on the development of acute ischemic lesions (AILs) at border zone (BZ) areas in patients with hypertensive ICH. Methods: We enrolled patients with acute hypertensive ICH (hemorrhagic lesions restricted to deep region [Strictly deep-ICH] or located in mixed lobar and deep areas [Mixed-ICH]) who received brain MRI within 7 days after ICH onset. BZ AILs were defined as lesions locating at BZ areas that were hyperintense on DWI sequence and hypointense on ADC series (figure). Acute SBP change was the difference between the initial SBP and the SBP recorded at 24 hours after ICH onset. Results: Of the 274 enrolled patients (62.5 ± 12.7 years old, 65% male), 11 subjects had BZ AILs. Compared to patients without BZ AILs, patients with lesions had wider amount of acute SBP reduction (71.7 ± 33.6 vs. 43.0 ± 32.2 mmHg, P = 0.023), more lobar and deep microbleeds (MB) and larger white matter hyperintensity volume (all p < 0.05). Using ROC curve analysis, acute SBP drop at more than 54mmHg was linked to the occurrence of AILs (sensitivity 82%, specificity 64%, P = 0.002). In multiple logistic regression model, acute SBP decline at above 54mmHg (OR 11.45, 95%CI 2.06 - 63.49, P = 0.005) and higher deep MB burden ( P = 0.032) raised the risk of AILs after adjustment for age, sex, and image markers of cerebral small vessel disease. In subgroup analysis, larger acute SBP drop remained to be an independent risk factor for development of AILs in patients with Mixed-ICH ( P = 0.008), but not in patients with strictly deep-ICH ( P = 0.715). Conclusion: Acute SBP change in hypertensive ICH, especially in Mixed-ICH, increases the risk of AILs at BZ areas, showing widespread microangiopathy that is vulnerable to rapid BP dysregulation to ischemia.

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451 THE BEST MARKER FOR COGNITION—RELATIVE HANDGRIP STRENGTH, ASYMMETRY OR WEAKNESS?

Age and Ageing ◽

10.1093/ageing/afab118.02 ◽

2021 ◽

Vol 50 (Supplement_2) ◽

pp. ii5-ii7

Author(s):

V Ho ◽

C Chen ◽

R A Merchant

Keyword(s):

Physical Activity ◽

Cognitive Function ◽

Cognitive Decline ◽

Handgrip Strength ◽

Demographic Characteristics ◽

Hand Dominance ◽

Perceived Health Status ◽

Cognitive Limitations ◽

Strength Asymmetry ◽

The Impact

Abstract Introduction Handgrip strength (HGS) is increasingly used to estimate overall muscle strength. Association between low HGS and cognitive decline has been well documented. Recently, McGrath’s team elucidated a new dimension of HGS asymmetry with important implications on physical and cognitive limitations. It is unclear if these effects can be generalised. The Asian working group for sarcopenia (AWGS) has called for ‘special considerations’ due to ‘anthropometric and cultural or lifestyle-related differences’6. Hence, we aim to investigate if HGS asymmetry is associated with cognition in Asians. Methodology We defined sarcopenia by AWGS consensus: HGS <28 kg for men; <18 kg for women. Asymmetry was HGS >10% stronger on either hand; relative HGS was HGS adjusted for BMI. Low cognitive function was defined as MMSE<26. We compared weakness alone, any HGS asymmetry or relative HGS alone and combination of weakness and HGS asymmetry or relative HGS asymmetry. Each model was adjusted for demographic characteristics, hand dominance, obesity, frailty, physical activity, depression and perceived health status. Results 738 Asian subjects participated. Mean age 70.8 ± 0.2 years, 45.1% males, 82.5% Chinese. More than 50% have multimorbidity. 5.4% were frail. Mean BMI 24.4 ± 0.1 kg/m2. Mean HGS 22.6 ± 0.3. 93 (12.7%) had symmetrical HGS and not weak, 59 (7.8%) asymmetrical and not weak, 321 (43.6%) symmetrical and weak, 265 (35.9%) asymmetrical and weak. Mean MMSE scores for weakness alone, asymmetry alone and combined weakness and asymmetry are 26.6 ± 0.1, 26.8 ± 0.2 and 26.5 ± 0.2 respectively. HGS asymmetry alone was not associated with better cognitive function OR 0.66 (95%CI: 0.30–1.44). Combined asymmetry and weakness was non-significantly linked to worse cognition OR 2.14 (95%CI: 0.79–5.82). We found relative HGS to be protective for cognitive decline, OR 0.31 (95%CI: 0.12–0.78, p = 0.012). Conclusion Our study highlights the impact of ethnicity in sarcopenia research. Our population shows association of relative HGS with cognition. Further longitudinal studies are needed.

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Subjective experience of cognitive function in affective disorders

European Psychiatry ◽

10.1016/s0924-9338(11)71944-7 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 234-234

Author(s):

K. Miskowiak ◽

M. Vinberg ◽

E.M. Christensen ◽

L.V. Kessing

Keyword(s):

Cognitive Function ◽

Cognitive Dysfunction ◽

Subjective Experience ◽

Unipolar Depression ◽

University Hospital ◽

Attention And Memory ◽

Cognitive Difficulties ◽

Affective Symptoms ◽

Patients Experience ◽

The Impact

IntroductionCognitive dysfunction in unipolar depression (UD) and bipolar disorder (BD) may persist into periods of remission and affect psychosocial function. Attention and memory deficits may be more pronounced during remission in BD compared with UD. However, patients’ subjective experience of cognitive difficulties is poorly understood, and it is unclear whether this differs between BD and UD.Aims and objectivesTo examine self-reported cognitive function in remitted patients with BD and UD.MethodsPatients with BD (n = 54) and UD (n = 45) were referred to the outpatient clinic at Department of Psychiatry, Copenhagen University Hospital, following hospital discharge.Affective symptoms and patients’ experience of cognitive symptoms were assessed at their initial consultation at the clinic.ResultsPatients in remission experienced mild to moderate impairment of cognitive function with greatest difficulties in motivation, energy, attention and memory. Subjective experience of cognitive function were similar for BD and UD and were predicted by affective symptoms rather than by diagnosis, age, gender or comorbid alcohol misuse.ConclusionsThe absence of differences between UD and BD in the subjective experience of cognitive difficulties contrasts with evidence of greater objective cognitive dysfunction in BD. This highlights a potential discord between subjective and objective measures of cognitive function. The impact of affective symptoms on the subjectively experienced cognitive difficulties suggests that they reflect mood symptoms rather than objective cognitive deficits. Further investigation of the relation between objective and subjective measures of cognitive function and the influence of affective symptoms is warranted.

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Adverse effects of ADT on cognitive function and dementia for men with prostate cancer: A meta-analysis and systematic review.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.6_suppl.150 ◽

2017 ◽

Vol 35 (6_suppl) ◽

pp. 150-150 ◽

Cited By ~ 1

Author(s):

Maxine Sun ◽

Alexander Cole ◽

Nawar Hanna ◽

Adam S. Kibel ◽

Toni K. Choueiri ◽

...

Keyword(s):

Prostate Cancer ◽

Systematic Review ◽

Cognitive Function ◽

Cognitive Decline ◽

English Language ◽

Meta Analysis ◽

Pooled Analysis ◽

Cochrane Library ◽

Significant Heterogeneity ◽

The Impact

150 Background: Nearly 50% of men diagnosed with prostate cancer may receive treatment with some form of androgen deprivation therapy (ADT). While some side effects of ADT are well acknowledged, the specific impact of ADT on cognitive function is uncertain. Our objective was to perform a systematic review and meta-analysis assessing the impact of ADT on overall cognitive decline, and the risks of Alzheimers, Parkinson’s disease. Methods: Relevant studies were identified through search of English language articles indexed in PubMed Medline, PsycINFO, Cochrane Library and Web of Knowledge/Science. First, we assessed rates of cognitive decline in five cohorts from three studies. Second, we assessed rates of Alzheimer’s or Parkinson disease using three large retrospective studies. A pooled-analysis was conducted using a meta-analysis. Weighted averages were reported as odds ratios (OR) with 95% confidence intervals (CI) using RevMan and a DerSimonian and Laird random-effects model. The heterogeneity test was measured using the Q-Mantel-Haenszel ( P< 0.10 was considered of significant heterogeneity). Results: With respect to overall cognitive decline (defined as scoring 1.5 standard deviations [SD] in two or more objective cognitive tests), patients receiving ADT had higher odds of overall cognitive decline than patients with prostate cancer not treated with ADT or health controls (OR: 2.03, 95% CI: 1.42–2.90). Furthermore, men with a history of ADT for prostate cancer had higher odds of developing Alzheimer’s and Parkinson dementia compared to men with prostate cancer not treated with ADT (OR: 1.32, 95% CI: 1.27–1.37). Conclusions: Men receiving ADT for prostate cancer performed significantly worse on measures of overall cognitive function. Additionally, results from the three large observational trials included suggest men exposed to ADT for prostate cancer have higher rates of Parkinson/Alzheimer’s compared to men without ADT.

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The Link Between Physical Activity and Cognitive Dysfunction in Alzheimer Disease

Physical Therapy ◽

10.2522/ptj.20140212 ◽

2015 ◽

Vol 95 (7) ◽

pp. 1046-1060 ◽

Cited By ~ 32

Author(s):

Cristy Phillips ◽

Mehmet Akif Baktir ◽

Devsmita Das ◽

Bill Lin ◽

Ahmad Salehi

Keyword(s):

Physical Activity ◽

Cognitive Function ◽

Alzheimer Disease ◽

Cognitive Decline ◽

Cognitive Dysfunction ◽

Physical Therapist ◽

Disease Process ◽

Sufficient Evidence ◽

Brain Disorder ◽

Neuroprotective Effects

Alzheimer disease (AD) is a primary cause of cognitive dysfunction in the elderly population worldwide. Despite the allocation of enormous amounts of funding and resources to studying this brain disorder, there are no effective pharmacological treatments for reducing the severity of pathology and restoring cognitive function in affected people. Recent reports on the failure of multiple clinical trials for AD have highlighted the need to diversify further the search for new therapeutic strategies for cognitive dysfunction. Thus, studies detailing the neuroprotective effects of physical activity (PA) on the brain in AD were reviewed, and mechanisms by which PA might mitigate AD-related cognitive decline were explored. A MEDLINE database search was used to generate a list of studies conducted between January 2007 and September 2014 (n=394). These studies, along with key references, were screened to identify those that assessed the effects of PA on AD-related biomarkers and cognitive function. The search was not limited on the basis of intensity, frequency, duration, or mode of activity. However, studies in which PA was combined with another intervention (eg, diet, pharmacotherapeutics, ovariectomy, cognitive training, behavioral therapy), and studies not written in English were excluded. Thirty-eight animal and human studies met entry criteria. Most of the studies suggested that PA attenuates neuropathology and positively affects cognitive function in AD. Although the literature lacked sufficient evidence to support precise PA guidelines, convergent evidence does suggest that the incorporation of regular PA into daily routines mitigates AD-related symptoms, especially when deployed earlier in the disease process. Here the protocols used to alter the progression of AD-related neuropathology and cognitive decline are highlighted, and the implications for physical therapist practice are discussed.

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Impact of Sinus Rhythm Maintenance on Major Adverse Cardiac and Cerebrovascular Events after Catheter Ablation of Atrial Fibrillation: Insights from AF Frontier Ablation Registry

10.22541/au.161058060.07089740/v1 ◽

2021 ◽

Author(s):

Keisuke Usuda ◽

Takeshi Kato ◽

Toyonobu Tsuda ◽

Hayato Tada ◽

Satoru Niwa ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Sinus Rhythm ◽

Primary Endpoint ◽

Cardiovascular Events ◽

Af Ablation ◽

Multicenter Cohort ◽

Cerebrovascular Events ◽

The Impact ◽

Sinus Rhythm Maintenance

Introduction: The impact of catheter ablation for atrial fibrillation (AF) on cardiovascular events and mortality is controversial. We investigated the impact of sinus rhythm maintenance on major adverse cardiac and cerebrovascular events after AF ablation from a Japanese multicenter cohort of AF ablation. Methods and Results: We investigated 2737 consecutive patients (25.6% female, mean age 63.4 ± 10.3 years) who underwent a first catheter ablation for AF from the Atrial Fibrillation registry to Follow the long-teRm Outcomes and use of aNTIcoagulants aftER Ablation (AF Frontier Ablation Registry). The primary endpoint was a composite of stroke, transient ischemic attack, cardiovascular events, and all-cause death. During a mean follow-up of 25.2 months, 2070 (75.6%) patients were free from AF after catheter ablation, and the primary composite endpoint occurred in 122 (4.5%) patients. The AF nonrecurrence group had a significantly lower incidence of the primary endpoint (1.7 per 100 person-years) compared with the AF recurrence group (3.2 per 100 person-years; P = 0.001). The multivariate analysis revealed that freedom from AF (hazard ratio 0.57; 95% confidence interval 0.39–0.83; P = 0.003) was independently associated with the incidence of the composite event.¬¬ Conclusion: In the multicenter cohort of AF ablation, sinus rhythm maintenance after catheter ablation was independently associated with lower rates of major adverse cardiac and cerebrovascular events.

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