Atrial fibrillation (AF) and dementia are highly prevalent chronic and debilitating conditions, especially affecting the older population. This review focuses on possible common pathophysiological mechanisms that could explain the association between the 2 conditions. Narrative review. Evidence from epidemiologic, observational, and interventional studies evaluating prevalence and incidence of cognitive impairment in patients with AF. Broad literature search between December 2022 and May 2023. Eligible categories for inclusion comprised interventional studies, observational studies, systematic reviews, and meta-analysis. Evidence from different cohorts has shown that AF increases the risk of dementia, although the association with dementia subtypes is not always unequivocal. According to recent evidence, common pathophysiological mechanisms include thromboembolism and hypercoagulable states, proinflammatory state, infection, cerebral hypoperfusion, and brain atrophy. Moreover, we reviewed the evidence on therapeutic measures to prevent dementia in patients with AF. Screening for cognition in patients with AF is of paramount importance, given the shared risk factors and common pathophysiological mechanisms. More evidence is needed to clarify whether antiarrhythmic and anticoagulant therapy have an impact on cognitive outcomes in AF patients.

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心房颤动和痴呆：关注共同的病理生理机制和治疗意义

心房颤动 (AF) 和痴呆症是非常普遍的慢性和衰弱性疾病，尤其影响老年人群。本综述重点关注可能的常见病理生理机制，这些机制可以解释这两种情况之间的关联。叙事回顾。来自评估 AF 患者认知障碍患病率和发生率的流行病学、观察性和干预性研究的证据。2022 年 12 月至 2023 年 5 月期间进行广泛的文献检索。符合纳入条件的类别包括干预性研究、观察性研究、系统评价和荟萃分析。来自不同人群的证据表明，房颤会增加患痴呆症的风险，尽管与痴呆亚型的关联并不总是明确的。根据最近的证据，常见的病理生理机制包括血栓栓塞和高凝状态、促炎状态、感染、脑灌注不足和脑萎缩。此外，我们回顾了预防房颤患者痴呆的治疗措施的证据。鉴于共同的危险因素和共同的病理生理机制，对 AF 患者进行认知筛查至关重要。需要更多证据来阐明抗心律失常和抗凝治疗是否对 AF 患者的认知结果产生影响。