Ischemic brain injury and cognitive impairmentin patients with atrial fibrillation

Authors: Golukhova E.Z., Shumilina M.V., Kabisova A.K.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery of Ministry of Health of the Russian Federation, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

For correspondence:  Sign in or register.

Type:  Heart rhythm disorders


For citation: Golukhova E.Z., Shumilina M.V., Kabisova A.K. Ischemic brain injury and cognitive impairment in patients with atrial fibrillation. Kreativnaya Kardiologiya (Creative Cardiology). 2018; 12 (1): 31–9 (in Russ.). DOI: 10.24022/1997-3187-2018-12-1-31-39.

Received / Accepted:  06.08.2017/08.08.2017

Keywords: atrial fibrillation silent cerebral infarctions cognitive impairment

Полнотекстовая версия:  



Atrial fibrillation is the most common form of cardiac arrhythmia, which is associated with high risk of stroke and post-stroke disability. Besides acute brain ischemic damage, neuroimaging assessment of patients with atrial fibrillation frequently reveals silent brain lesions, and the quantity and volume of the latter correlate with cognitive dysfunction in these patients. In the present review we summarized the results of contemporary studies of mechanisms of ischemic brain damage in patients with atrial fibrillation, the data of the association between cognitive dysfunction/dementia and atrial fibrillation in cardiologic patients. In addition, we considered the problem of diagnosis of cognitive dysfunction in patients with heart diseases.


  1. Schnabel Renate B., Yin Xiaoyan, Gona Philimon et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet. 2015; 11; 386 (9989): 154–62.

  2. Bockeria L.A. Prevention of stroke associated withatrial fibrillation. Annals of Arrhythmology (AnnalyAritmologii). 2005; 2 (3): 45–54. (in Russ.).

  3. Rahman F., Kwan G.F., Benjamin E.J. Global epidemiology of atrial fibrillation. Nat. Rev. Cardiol. 2014; 11 (11): 639–54.

  4. Kirchhof P., Benussi S., Kotecha D. et al. 2016 Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. EP Europace. 2016; 18 (11): 1609–78.

  5. Shah A.D., Merchant F.M., Delurgio B. Atrial fibrillation and risk of dementia/cognitive decline. J. Atr. Fibrillation. 2016; 8 (5): 1353.

  6. Wong C.X. et al. Epidemiology of atrial fibrillation: the australian and asia-pacific perspective. Heart Lung Circ. 2017; 26 (9): 870–9.

  7. Ahmad Y., Lip G.Y.H., Lane D.A. Recent developments in understanding epidemiology and risk determinants of atrial fibrillation as a cause of stroke. Can. J. Cardiol. 2013; 29 (7): S4–13.

  8. Kostenko E.V., Polunin V.S., Polunina N.V.Impact of Comorbidities on Rehabilitation afterStroke. Medical Care (Lechebnoe Delo).2017; 4:27–33 (in Russ.).

  9. Macle L., Cairns J., Leblanc K. et al. Focused update of the canadian cardiovascular society guidelines for the management of atrial fibrillation. Can. J. Cardiol. 2016; 32 (10): 1170–85.

  10. Kuznetsov A.L. Ischemic stroke: the risk of cere-bral embolism in various forms of cardiac patholo-gy: Cand. Med. Sc. Diss. Moscow; 2002 (in Russ.).

  11. Sulimov V.A. Diagnosis and treatment of atrial fib-rillation: Recommendations RSC, RSSA ANDACS. Russian Cardiology Journal (Rossiyskiy Kardiologicheskiy Zhurnal).2013; 4 (102): 89(in Russ.).

  12. Koizumi R. et al. Numerical analysis of hemodynamic changes in the left atrium due to atrial fibrillation. J. Biomech. 2015; 48 (3): 472–8.

  13. Kalantarian S., Stern T.A., Mansour M., Ruskin J.N. Cognitive impairment associated with atrial fibrillation: a meta-analysis. Ann. Int. Med. 2013; 158 (501): 338–46.

  14. Skvortsova V.I., Ivanova G.E., Stakhovskaya L.V.Possibilities of expanding the rehabilitation poten-tial of patients with cerebral stroke. RussianMedical Journal (Russkiy Meditsinskiy Zhurnal).2011 (9): 579–83 (in Russ.)

  15. Ferro J.M. Atrial fibrillation and cardioembolic stroke. Minerva Cardioangiol. 2004; 52 (2): 111–24.

  16. Sakamoto Y. et al. Low DWI-ASPECTS is associated with atrial fibrillation in acute stroke with the middle cerebral artery trunk occlusion. J. Neurol. Sci. 2012; 323 (1–2): 99–103.

  17. Tian M.J., Tayal A.H., Schlenk E.A. Predictors of poor hospital discharge outcome in acute stroke due to atrial fibrillation. J. Neurosci. Nurs. 2015; 47 (1): 20–6.

  18. Acciarresi M., Paciaroni M., Agnelli G. et al. Prestroke CHA2DS2–VASc score and severity of acute stroke in patients with atrial fibrillation: findings from RAF study. J. Stroke Cerebrovasc. Dis. 2017; 26 (6): 1363–8.

  19. Kimura K., Iguchi Y., Shibazaki K., Iwanaga T., Yamashita S., Aoki J. et al. IV t-PA therapy in acute stroke patients with atrial fibrillation. J. Neurol. Sci. 2009; 276 (1–2): 6–8.

  20. January C.T. et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014; 130 (23): 199–267.

  21. Nademanee K., Amnueypol M. Left atrial ablation of atrial fibrillation: is the fly in the ointment a silent stroke? J. Cardiovasc. Electrophysiol. 2012; 23 (6): 574–5.

  22. Cha M. et al. Prevalence of and risk factors for silent ischemic stroke in patients with atrial fibrillation as determined by brain magnetic resonance imaging. Am. J. Cardiol. 2014; 113 (4): 655–61.

  23. Rybalko N.V. Differential diagnosis and clinicalsignificance of various variants of cardiogenic arte-rio-arterial cerebral embolism: Dr. Med. Sc. Diss.Moscow; 2016 (in Russ.).

  24. Ott A., Breteler M.M., de Bruyne M.C., van Harskamp F., Grobbee D.E., Hofman A. Atrial fibrillation and dementia in a population-based study the Rotterdam Study. Stroke. 1997; 28: 316–21.

  25. Santangeli P., Di Biase L., Bai R. Atrial fibrillation and the risk of incident dementia: a meta-analysis. Heart Rhythm. 2012; 9: 1761–8.

  26. Kwok C., Loke Y., Hale R. et al. Atrial fibrillation and incidence of dementia A systematic review and meta-analysis. Neurology. 2011; 76: 914–22.

  27. Singh-Manoux A., Fayosse A., Sabia S. et al. Atrial fibrillation as a risk factor for cognitive decline and dementia. Eur. Heart J. 2017; 38 (34): 2612–8.

  28. Kornej J., Apostolakis S., Bollmann A., Lip G.Y.H. The emerging role of biomarkers in atrial fibrillation. Can. J. Cardiol. 2013; 29 (10): 1181–93.

  29. Weymann A., Sabashnikov A., Ali-Hasan-Al-Saegh S., Popov A.-F., Jalil Mirhosseini S., Baker W.L. et al. Predictive role of coagulation, fibrinolytic, and endothelial markers in patients with atrial fibrillation, stroke, and thromboembolism: a meta-analysis, meta-regression, and systematic review. Med. Sci. Monit. Basic Res. 2017; 23: 97–140.

  30. Leithäuser B., Jung F., Park J.-W. Rheological and hemostasiological aspects of thrombus formation in the left atrial appendage in atrial fibrillation? A new strategy for prevention of cardioembolic stroke. Clin. Hemorheol. Microcirc. 2010; 45 (2–4): 311–23.

  31. Kim Y.-H., Roh S.-Y. The mechanism of and preventive therapy for stroke in patients with atrial fibrillation. J. Stroke. 2016; 18 (2): 129–37.

  32. Kholodenko M.I. Disorders of venous circulationin the brain. Moscow: Medgiz; 1963 (in Russ.).

  33. Shumilina M.V. Venous circulation disturbances inpatients with cardiovascular pathology. Dr. Med.Sc. Diss. Author's abstract. Moscow; 2002(in Russ.).

  34. Semenov S.E., Shumilina M.V., Zhuchkova E.A.,Semenov A.S. The Diagnostics of cerebral venousischemia. Clinical Physiology of Circulaiton(Klinicheskaya Fiziologiya Krovoobrashcheniya).2015 (2): 5–15 (in Russ.).

  35. Petersen P., Kastrup J., Videbaek R., Boysen G. Cerebral blood flow before and after cardioversion of atrial fibrillation. J. Cerebral. Blood Flow Met. 1989; 9: 422–5.

  36. Schmidt R., Schmidt H., Curb J.D., Masaki K., White L.R., Launer L.J. Early inflammation and dementia: a 25-year follow-up of the Honolulu-Asia Aging Study. Ann. Neurol. 2002; 52: 168–74.

  37. Hui D.S., Morley J.E., Mikolajczak P.C., Lee R. Atrial fibrillation: A major risk factor for cognitive decline. Am. Heart J. 2015; 169 (4): 448–56.

  38. Folstein M.F., Folstein S., McHugh P.R. Minimental status. A practical method for grading the cognitive state of patients for the clinician. J. Psych. Res. 1975; 12 (3): 189–98.

  39. Shnayder N.A., Salmina A.B. Neurological com-plications of general anesthesia. 2th ed. Moscow:Medika; 2009; 280 (in Russ.).

  40. Nasreddine Z.S., Phillips N.A., Bedirian V., Charbonneau S., Whitehead V., Collin I. et al. The montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J. Am. Geriatr. Soc. 2005; 53 (4): 695–9.

  41. Demenko T.N., Chumakova G.A., Chugu-nova Yu.V. Cognitive function in patients with atri-al fibrillation. Annals of Arrhythmology (AnnalyAritmologii).2015; 12 (4): 215–24 (in Russ.).

About Authors

  • Golukhova Elena Zelikovna, Dr Med. Sc., Professor, Academician of Russian Academy of Sciences, Head of Department, Deputy Chief Editor of the Journal,;
  • Shumilina Margarita Vladimirovna, Dr Med. Sc., Head of Department, Ultrasonic Diagnostics Physician,;
  • Kabisova Agunda Kaurbegovna, Cardiologist, Junior Researcher,

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery