David A. Nardone, MD
Potential Conflicts of Interest: None disclosed.
Nardone DA. Cognitive Impairment Associated With Atrial Fibrillation. Ann Intern Med. 2013;158:849. doi: 10.7326/0003-4819-158-11-201306040-00015
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Published: Ann Intern Med. 2013;158(11):849.
TO THE EDITOR:
Kalantarian and colleagues’ recent meta-analysis (1) showed that atrial fibrillation (AF) predicts cognitive impairment and dementia and that further study is recommended to clarify any association between AF and subtypes of dementia. I agree with their conclusion but suggest an equal focus on assessing any difference in the risk for cognitive decline according to 3 AF subtypes: paroxysmal, persistent, and permanent.
Several studies support the value of AF categorization. Patients with subclinical AF of longer duration may have a higher incidence of stroke (2). Atrial fibrillation burden (≤5 minutes per day, >5 minutes but <24 hours per day, and ≥24 hours per day) may strengthen CHADS models for predicting risk for thromboembolism (3). Patients with AF may have lower brain volume than those without AF. This association seems to be strongest for patients with persistent and permanent AF (4). Short-term outcomes in patients with persistent AF and acute cerebral infarction may be worse than in those with paroxysmal AF and infarction (5).
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