Emergency Cardiology and Cardiovascular Risks · Jul 21, 2026

Cognitive Impairment and Atrial Fibrillation: Epidemiology, Pathophysiological Mechanisms, Risk Factors, and Future Perspectives

By Tsimenava SV, Snezhitskiy VА, Демьянович КС et al.

Atrial fibrillation (AF) and dementia represent the most prevalent non-communicable diseases affecting the aging population posing a substantial burden on healthcare systems. For a long time, this comorbidity was attributed solely to shared risk factors. However, accumulating evidence from prospective studies indicates that AF per se is independently associated with an increased risk of cognitive impairment and dementia, even in patients without a history of stroke. This review analyzes the methodological challenges inherent in studying this relationship and synthesizes current evidence on the pathophysiological mechanisms linking AF to cognitive decline. The following pathways are examined: cerebral hypoperfusion, silent microembolization, cerebral microangiopathy, and chronic systemic inflammation. Additionally, data on the effects of various AF management strategies (anticoagulant therapy, rhythm control) on cognitive function are presented.

doi.org/10.51922/2616-633x.2026.10.1.2716Open accessMechanisms