AFIB & dementia

There is a strong correlation between AFIB and dementia. Prevalence of AFIB and dementia are both increasing with aging population.

There have been several meta-analyses looking dementia in patients with AFIB.

1. Study by Kwok in Neurology – 46.637 patients – twice the risk of dementia in patients with AFIB.
2. Study by Santangeli in Heart Rhythm – 77,668 patients – 42% increase in risk of dementia in patients with AFIB.

Dublin et. al. published a prospective study that while smaller confirmed the above findings.

The Intermountain Healthcare group in Utah has had several publications on this issue:

1. AFIB increased risk dementia (senile, vascular and Alzheimer’s) and death – retrospective study .
2. AFIB ablation reduced risk of dementia – retrospective study

There are several mechanisms by which AFIB can contribute to dementia:

1. Low blood flow to brain due to inefficient heart function.
2. Stroke.
3. A series of small strokes – microemboli.
4. A series of small brain bleeds related to anticoagulants.
5. Inflammation – the same process that leads to AFIB also contributes to dementia.

How to prevent dementia with atrial fibrillation?

1. Take anticoagulants if indicated based on CHA2DS2-VaSC score.
2. Don’t get AFIB by aggressively modifying lifestyle. There may be an indirect correlation with AFIB and dementia i.e. same lifestyle factors that cause dementia – high blood pressure, high lipids, smoking, lack of exercise, poor sleep habits – may also cause AFIB.
3. I am NOT prepared to say that maintaining normal rhythm with ablation or antiarrhythmic drugs will reduce risk of dementia though this is often insinuated by others. The studies are small/scattered and the procedure or stronger drugs also carry their own risks.