Fibrilação atrial e demência

Abstract

Atrial fibrillation (AF) is the most common arrhythmia and its prevalence is higher in the elderly. It is classified in paroxysmal AF, persistent and continuous, which are part of the development of a continuous disease. The main complication related to atrial fibrillation is stroke. The occurrence of stroke is directly related to cognitive impairment and dementia, this being a condition with great disabling potential and higher morbidity and mortality. The main mechanisms linking AF and dementia are the occurrence of brain lesions caused by silent ischemic cerebral infarction and cerebral hypoperfusion caused by reduced cardiac output. The FA implies the electrical and structural remodeling of the heart. The inflammatory process is closely linked to the development of the FA, which can be demonstrated by altered levels of inflammatory mediators. For the prevention of stroke and subsequent cognitive impairment and dementia development, the main therapeutic strategy consists of using anticoagulants therapy. For a long time, warfarin is used, however, this use carries the risk of bleeding, which also favor the development of dementia. The new oral anticoagulants have emerged as an alternative and with a lower risk of bleeding compared to warfarin. However, several aspects must be evaluated for choosing the appropriate therapy in each case. Clearly there is a relation between AF and dementia, however, further studies are needed to fully clarify this relationship, which will also allow the use of more effective therapeutic strategies.