AF and dementia issues

[WendyWu20]

This post is not intended to scare anyone. The issue with dementia is an uncomfortable one, but needs exploring on both a medical and individual level, if we are to help ourselves and be empowered along our path towards enjoying good health. Aged 53, I'm only just beginning to link my own problems of 'word finding' and 'word retrieval' difficulties with having AF.

If anyone reading this has any worries about their own health issues, they should seek medical advice.

The following article provides a review of current research:

ecrjournal.com/articles/atr...

Here are some of the findings:

'In a study in Germany... those people with AF performed significantly worse in learning, memory and executive function tasks'.

'...they found that persistent but not paroxysmal AF was associated with lower cognitive function. These findings suggest that AF burden, in addition to its presence, may influence cognitive function.'

'The association (of dementia) was stronger in women and younger (<65 years of age) participants.'

'AF is associated with at least a doubling of stroke risk and the effects of stroke on cognitive function are well established. Despite this, elevated stroke risk does not completely mediate the increased risk of dementia and cognitive decline associated with AF. Other mechanisms such as silent cerebral infarcts, microbleeds associated with oral anticoagulation and cerebral hypoperfusion are likely to play a role.' 'Patients with AF have been found to have reduced cerebral perfusion'.

'Hypoperfusion' stood out for me. It is an inadequate supply of oxygen and nutrients (to the brain). When I'm in AF, I'm often short of breath, and also feel like I can't think or concentrate. So I'm currently training myself to breathe more deeply at regular intervals.

Also, 'A recent analysis comparing the risk of dementia in patients with AF using warfarin versus non-vitamin K oral anticoagulants reported a lower risk of dementia among non-vitamin K oral anticoagulant users.'

Again, this post is not intended to scare anyone. On the contrary - these research findings should be used by all of us AF sufferers as a way of increasing our self-knowledge and self-empowerment. We should be able to have informed discussions with our doctors, about the ways in which we can prevent secondary issues such as cognitive impairment.

I’m hoping we can have a useful discussion of the ways we can all support our healthy cognitive functioning! :o)

[Finvola]

A very timely post in the light of recent reports into the protective effects of anticoagulation in the incidence of dementia in AF patients as posted by Koll and other members yesterday.

In trying to keep my cognitive functions as sharp as I can, I do puzzles - word, number and logic - and have recently started mindfulness meditation. One of the benefits of Mindfulness is its enhancing effect on the executive function centre of the brain, as well as improving the overall sense of well being.

I agree that we should all be aware of the possibilities with this condition and take action where we can.

Thank you for posting.

[BobD Volunteer]

Once again the importance of anticoagulation is obvious as per the recent report on such matters.

[WendyWu20 in reply to BobD]

Yes, anticoagulation is an important aspect, especially looking at the research highlighting the benefits of non vitamin k oral anticoagulants over the warfarin types, for a lower risk of dementia.

[BobD Volunteer in reply to WendyWu20]

I suspect that this is mainly due to variations (failure to remain in range) in INR with warfarin. Those of us lucky enough to have stable INR should be well protected at least from what I have read. The main advantage (apart from freedom of diet etc) of NOACs is stability.

[WendyWu20]

It may also be useful to point out the difference between 'cognitive impairment' and 'dementia'. While symptoms of dementia may include cognitive impairment, having a medically diagnosed cognitive impairment does not mean someone has dementia.

Measuring cognitive impairment usually includes things such as short term memory, language, visuospatial abilities, planning, organisation and divided attention.

The study showing that persistent, but not paroxysmal AF, is associated with lower cognitive function, is interesting. It may support the view that reduced oxygen to the brain during AF episodes is a factor.

There are also a few different types of dementia. The main ones include Alzheimers and vascular dementia. Low levels of oxygen in the brain (hypoperfusion) are associated with the vascular type of dementia.

[wilsond in reply to WendyWu20]

Thats very true , cognitive impairment is not the same as dementia and if we can help ourselves by trying to keep 'upstairs' well ventilated,and keep taking the anticoags,Im sure we can help reduce the risks.

[10gingercats]

It is also important to learn new skills and to keep practicing them and acquiring new skills .I started to learn the piano 10 years ago and have recently taken up pastel work and Tai Chi in an effort to create new neurons.

[WendyWu20 in reply to 10gingercats]

Wow, that's really impressive :o)

[CDreamer]

Very interesting post, thank you.

Quite topical for me as my neurologist has asked (nagged) my GP to refer me to the Memory Clinic, mainly for a baseline reading as I am told I would not be eligible for any treatments, because I have been experiencing cognitive impairment for the last few years. I find it comes and goes, some days better than others but as I have othe conditions with symptoms which can mimic stroke symptoms I can often bamboozle doctors, heading for another head MRI scan next week.

For about 12 months 2016 - 2917, I underwent HBOT - hyperbaric Oxygen treatment - breathing 100% O2 under more than atmospheric pressure. This is used as a very effective treatment for strokes, MS, brain trauma as well as burns - cells absorb much more O2 under pressure, enabling healing. If tissue has died it cannot be revived but research (mainly in Israel) has shown that damaged tissue at the margins can heal and patients can recover very much more quickly with this treatment so what you say about breathlessness sort of fits. I bought an oximeter and monitored my sats whilst undergoing treatment and whereas my sat levels on average were 92-95 they improved so that I now average 94-98 and occasionally 100. I also noticed a big improvement with brain fog symptoms after about 6 weeks of saturation treatment during that time and although I still have bad days, It isn’t as severe.

,

[WendyWu20 in reply to CDreamer]

It's good that you feel an improvement after the hyperbaric oxygen therapy. Unfortunately this treatment is not a viable option for most people, due to the expense, risks involved, and contraindications with many illnesses.

I used to work in a memory clinic, we found that many patients experienced an improved quality of life from taking the current medications available. We used the Mini Mental State Examination for quick baseline testing, plus asking the patient to draw a clock face set for quarter past ten. It is downloadable from here:

dementiatoday.com/wp-conten...

The Wechsler Memory Scale may also be used, it's longer and gives a more in depth assessment.

I'm hoping to discuss the cognitive impairment and hypoperfusion issue when I see an EP next month.

[Hidden]

The important aspect is anticoagulation to reduce the risk of stroke, but there may be other factors in play too. From my experience neuroplasticity continues in the six months after a stroke but at a diminished rate. Before the stroke my SpO2 was always 100% and post stroke it's 98%. This is no doubt influenced by cardio exercise and is encouraged by my Consultant Neurologist as hyperbaric treatment is not available in this CCG.

[rosyG]

I haven't seen this myself but a medical friend mentioned on the phone that there was an article in the paper this week that said AF sufferers who were anti-coagulated had a 40 plus reduction in the onset of Dementia !! I assume it's because we don't get the micro emboli which result from ageing problems but are not recorded

We have to be careful about what is in the papers but it sounds good!!!

[WendyWu20 in reply to rosyG]

Research seems to suggest that there is less chance of getting dementia if a person's anti-coagulation levels remain consistently within the ideal limits. Some people find this difficult with Warfarin types. Too little anti-coagulation and increased risk of stroke; too high, and increased risk of bleeds. So the New Oral anti-coags seem better at keeping people within the ideal range, and thus reducing the risk of impaired cognition and dementia.

[wilsond in reply to rosyG]

Thank you Rosyg! A 'friend' put the wind up me properly yesterday ,saying that I was 45%more likely than her to get dementia ,as i have AF!been exploring the forum to put my fevered imagination at rest.Thank you for your post ,helped a lot.(and I think I shall review my friend !ist!)

[Meeko]

I get bouts of trouble with word finding and sentence building. I put it down to allergy symptoms before being diagnosed with PAF. Since starting rivaroxaban brain fog is better.

[WendyWu20 in reply to Meeko]

That's interesting, but I'm not sure of the mechanisms behind it, maybe you could ask your doctor?

[souljacs4]

I am dyslexic so I cant do some of the tests such as spelling things backwards I cant spell them the right way most of the time and as for counting backward its a lost cause.

[WendyWu20 in reply to souljacs4]

If you were ever in a position where you needed a test, you'd just tell the health professional that you have dyslexia, and they could find an alternative way of testing you :o)

[souljacs4]

Thank you Wendy that's good to know.

[akenclark]

Thank you for raising this and making the observation that your concentration is off when you are breathless. I have arrhythmia and Kardia identifies short bursts of possible AF when I walk uphill in the neighborhood. I have been taking myself off coffee and alcohol (sniff!) trying to reduce stressors. Being a Canadian citizen resident in USA I have some complex cross-border tax and reporting issues that require focus and clarity. I was procrastinating terribly on my FBAR (Foreign Bank and Financial Accounts Report) because I was constantly "fuzzy headed" and had lost the confidence to do it. In the end I found setting aside a few hours to work and fortifying myself with one strong coffee got me functional.

[WendyWu20]

Although there seems to be substantial scientific research showing the effects of lowered cardiac output during episodes of AF, and the resulting lack of oxygen to the brain - little remedial or therapeutic measures are being put into practice by healthcare professionals.

I intend bringing up this topic when I see an EP for the first time in December. In the meantime, I'll continue practicing deep regular breathing when in AF, and not doing anything that makes me more breathless.

I wonder what are the long term cognitive effects of suffering persistent AF? I definitely feel complete brain fog during an episode, but the memory problems persist on a daily basis.

Do many people on this forum measure there oxygen saturation levels? There are finger pulse oximeters available - does anyone here use these?

[souljacs4 in reply to WendyWu20]

I have two one I keep at home and one I take with me when out and about.

[wilsond]

Thank you Wendywu20,very interesting.I shall keep up the tai chi as it uses breathing techniques a lot.You can watch and copy on youtube too