A link between atrial fibrillation and dementia? Anticoagulants also cause dementia?
(by Nicola Simonetti) When dementia hides behind atrial fibrillation. They seem so far away from the heart and the brain and instead, when the heart fails to beat regularly and, for example, the two atria (commonly called orecchiette) open and close with accentuated and irregular frequency, small clots can start from the heart. blood, they can reach the contents of the skull and cause stroke and, in perspective, dementia.
Atrial fibrillation is notoriously associated with an increased risk of stroke and dementia because brain anatomical lesions, over time, translate into progressive cognitive decline.
It has been demonstrated that - he said, at the Congress "Knowing and taking care of the heart" in Florence, prof. Francesco Prati, president of the Foundation for the fight against heart attack - patients with atrial fibrillation had higher rates of total dementia (5.8% vs 1.6%), Alzheimer's disease (2.8% vs 0.9%) and vascular dementia (1.0%) versus 0.2%) than the others. Delay in setting up anticoagulant therapy in atrial fibrillation also appears to be associated with an increased risk of dementia. Atrial fibrillation has been shown to be associated with both reduced brain volume and memory impairment, regardless of signs of a cerebral infarction. It is therefore plausible, given the association between atrial fibrillation and stroke, that microemboli may play a role in the association between atrial fibrillation and dementia and, intuitively, that oral anticoagulation can reduce this risk. In fact, small foci of intracerebral hemorrhage could be the basis for the initiation / accentuation of a dementia process.
It is up to the doctor to evaluate the risk / benefit ratio from time to time and to adjust according to the preponderance of one of the two factors.
The socio-economic burden of dementia is significant: over 44 million and a half people, in the world, are affected by a form of dementia, of which over one million only in Italy. The new cases of illness are every year over 7.7 millions: a new case every 4 seconds.