Atrial Fibrillation’s Link to Dementia
Here's what you can do to delay cognitive decline.
By Regina Boyle Wheeler
Medically Reviewed by Farrokh Sohrabi, MD
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Dementia and other forms of cognitive decline can significantly diminish quality of life. Forgetfulness, trouble communicating, and even difficulty getting dressed and eating are common signs of dementia. In trying to get to the root of this debilitating condition, researchers have uncovered a link between atrial fibrillation (afib), heart disease, and dementia that might not seem obvious at first.
People with atrial fibrillation face a greater risk for stroke, which can take a devastating toll on physical and mental functioning. Additionally, emerging research suggests that afib may put people at increased risk for cognitive decline, even if they haven't suffered a stroke.
Advancing age is a major risk factor for both conditions, but it looks like there's more to the connection.
The American Heart Association estimates that some 2.7 million Americans have atrial fibrillation, the most common form of irregular heartbeat. Faulty signals in the heart's electrical system cause the upper chambers, the atria, to contract very fast and irregularly. As a result, blood isn't pumped efficiently and can pool in the atria. Pooled blood can clot and can cause a stroke if the clot travels to the brain. If you have other risk factors for stroke, including diabetes, high blood pressure, and heart failure, your chances of having a stroke increase.
Atrial Fibrillation and Dementia: What’s the Link?
Several studies have shown a link between afib and cognitive decline, even in people who haven’t had a stroke. Research published in the journal Neurology found that the irregular heartbeat can speed up mental decline.
Researchers collected information on more than 5,000 people aged 65 and older who participated in the Cardiovascular Health Study. None had atrial fibrillation at the beginning of the study. Over an average of seven years of follow-up, more than 550 people in the group developed afib.
Every year during the study, participants were given a scored memory and thinking test. The researchers found that people with atrial fibrillation were more likely to have lower scores on the test at an earlier age than those who didn't develop the irregular heartbeat.
“We used statistical calculations to determine that this association [atrial fibrillation and cognitive decline] was probably not due to other illnesses that occur commonly along with atrial fibrillation and may cause cognitive decline, such as high blood pressure, heart failure, and diabetes,” says Evan Thacker, PhD, lead author on the study and a chronic disease epidemiologist and assistant professor in the Department of Health Science at Brigham Young University in Provo, Utah.
“The association we saw in our study has also been seen consistently in many other studies, conducted in different populations at different times,” Thacker adds.
“The research provides further evidence that afib may represent an independent risk factor for cognitive decline, although a better understanding of the mechanisms underlying this relationship is needed,” says Patrick Smith, PhD, an assistant professor of medical psychology with an interest in cardiovascular disease and cognition at Duke University Medical Center in Durham, North Carolina.
People with atrial fibrillation who took blood thinners, and kept within the target blood levels, had fewer cases of dementia, found a study published in the journal Heart Rhythm. Jared Bunch, MD and colleagues found that patients whose warfarin levels were in the target range more than 75 percent of the time were four times less likely to develop dementia compared with patients whose levels were in the target range only 26 percent to 50 percent of the time.
What Causes Mental Decline?
What could be behind atrial fibrillation and cognitive decline in the absence of a major stroke? A number of factors may come into play:
Small strokes. It's possible that people with atrial fibrillation could have small, silent strokes that don't cause major cognitive problems in isolation. In fact, someone can have a silent stroke and not realize anything happened. The cumulative effect of several silent strokes, however, can have an effect on mental functioning over time, says Patrick Tchou, MD, a staff cardiologist in electrophysiology and pacing at the Cleveland Clinic in Ohio. Smith notes that better brain imaging in the last decade has allowed doctors to see that silent strokes have occurred and the damage they've caused.
Impaired blood flow and other physical changes. Because atrial fibrillation affects the heart's ability to pump blood efficiently, the brain may not be getting enough oxygen and glucose, which could also affect cognition, explains Brendan Kelley, MD, a neurologist at the Ohio State University Wexner Medical Center in Columbus.
Physical inactivity. Dr. Tchou says that atrial fibrillation may affect the ability to exercise, especially in the elderly, leading to faster mental decline. A study published in the The Lancet Neurology concluded that about half of dementia and Alzheimer’s cases are due to potentially modifiable risk factors. These include inactivity, smoking, and diabetes.
RELATED: How Your Blood Thinner Affects Your Brain — And Dementia Risk
5 Strategies to Stave Off Cognitive Decline
To prevent cognitive problems when you have atrial fibrillation, consider these methods:
- Stick to your checkup schedule. See your heart doctor as recommended to make sure your atrial fibrillation is under optimal control, says Kelley. Other than medication, heart procedures and surgery can be effective at keeping your heart in rhythm.
- Take your blood thinners. If your doctor has prescribed blood thinners, Tchou says, it's important to take them as directed to prevent a clot and reduce your chances of having a stroke. If you are taking warfarin, keeping your blood levels of the drug in the target range will help, too.
- Report medication side effects. Beta blockers are a common atrial fibrillation medication used to slow down the heart rate. Tchou says these medications can sometimes have a depressant effect. This may lead people to engage in less mental and physical activity, causing cognition problems. Mellanie True Hills, who has atrial fibrillation and founded Stopafib.org, a website about heart arrhythmias, says that in her experience, "brain fog" from beta blockers can mimic signs of dementia. "I personally know the impact of beta blockers on myself and others, and it's not fun," she says. Lowering the dose of the beta blocker or selecting ones that do not penetrate the brain as much may help to reduce those side effects, Tchou says.
- Treat sleep apnea. Sleep apnea is a common but serious sleep disorder that causes you to temporarily stop breathing multiple times during the night, depriving the brain of oxygen. Sleep apnea can lead to many health issues, including memory problems and atrial fibrillation. "Research out of the Mayo Clinic shows that 50 percent or more of those with atrial fibrillation also have sleep apnea," says Hills. "I personally know from the atrial fibrillation community that many of those cases of sleep apnea are not being diagnosed." If you suspect you may have this sleep disorder, talk with your doctor about testing and treatment.
- Make healthy diet and exercise choices every day."What's good for the heart is good for the brain," advises Smith.
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