AF and Cognitive Decline

[Kaz747]

There has been a lot in the news here in Australia over the past week or so about the link between AF and cognitive decline/dementia. As someone who is caring for a mother with dementia, it is not good news. That said, at least I'm on anti-coagulants and my AF is under control thanks to my ablations, medication and magnesium.

I have written up a summary of the interview with Professor Ben Freedman from the Heart Research Institute in Sydney. He is a Professor of Cardiology and Deputy Director of Research at the Institute. The interview was conducted by Dr Vivienne Miller, Sydney GP on a National Australian Radio Show – Healthy Living 17/4/22.

Cognitive decline is defined as a reduction in the processing of the brain of a wide range of things, not just memory as in dementia, as people typically think of it. It includes planning, managing and initiative to do things.

Doctors know that treating AF with anti-coagulants can reduce risk of strokes. What’s new in the research is an increasing awareness that dementia or cognitive decline – not being able to think as clearly - is strongly associated with AF. Researchers wonder if it might be potentially preventable like strokes are preventable thanks to anti-coagulants.

They are not 100% sure if AF causes dementia or if it is just associated with it. There is a lot of evidence however that AF is, in part at least, causal and so detecting AF early is vital.

It may be related to brain function through throwing off tiny clots that are not clinically significant but they are enough to lodge in the very small arteries in the brain and cause blood flow issues and death of brain tissue in very small areas without appearing as a stroke on a scan.

Doctors know that if you’ve had a stroke, and with AF you tend to get bigger strokes, then your risk of getting dementia in the next few years doubles or triples. People may get small, mini-strokes that they are not aware of but when doctors do brain scans they see more of these signs in people with AF than in people without it. It may be cumulative as small bits of clots go off to the brain. When your heart is completely irregular all the time, you may not be getting enough blood and oxygen to the brain which adds to cognitive decline.

What is the effect of treating AF on cognitive decline? They don’t know yet but there is a suggestion that there is a dose affect. The more AF and the more persistent it is, the more the burden of AF, the more likely you are to get cognitive decline and dementia. Because of that relationship, it would stand to reason that if you can reduce AF, it can reduce risk of cognitive decline.

Anticoagulants cut stroke risk by 64%. There is a trial going on called “Brain AF” where people with not enough risk to have a stroke (low CHA2DS2-VASc) are given anticoagulants or a placebo and in a couple of years what they will measure is not stroke so much, but cognitive function. They are doing very intense tests of how people think now and they will be retested at the end of the trial. If they find an answer there, that will be a very clear message.

- - - - -

As someone said in the last few days, AF is the gift that keeps on giving 😀.

So, keep fit and well, eat healthy, build movement into your every day life, sleep well, relax, meditate, stay connected with your community and keep building new neural pathways by learning new things. Oh... and don't forget your medication.

[sassy59]

Very interesting Kaz, thank you for that. Xxx

[BobD Volunteer]

I don't think this is particularly new Kaz. I seem to recall Mark S commenting maybe five or more years ago that it was very likely the micro embolii released by the fibrillating heart which were the cause. The discussion was from memory about why anticoagulation was now continued during ablation procedure rather than stopped in advance as it used to be. If so then it may well be ten or more years ago.

[Kaz747 in reply to BobD]

Thanks Bob. My takeaway was that researchers are looking at the benefits of anticoagulants for more people with AF because of the benefits to the brain, not just reducing stroke risk.

[BobD Volunteer in reply to Kaz747]

Agreed completely. I have alwasy been a great advocate for anticoagulation for all AF patients.

[MarkS in reply to BobD]

Bob has a good memory and has obviously been taking his warfarin!

There are at least two studies showing the reduction in dementia with anticoagulant use, this is one:

Anticoagulants Linked to Reduced Dementia Risk in AF:

medscape.com/viewarticle/90...

Patients with AF were 40% more likely to develop dementia, but anticoagulant use reduced risk by 60% (i.e. back to the risk for a non-AFer)

[Kaz747 in reply to MarkS]

Thanks Mark

[Buffafly]

My ‘old’ GP told me not to ignore high HR with AF because lack of oxygen ‘kills off your little grey cells’. That was scary but as so many of us have found A&E don’t seem to worry too much unless your BP or SATS drop to a dangerous level 😟 Perhaps we should all have oximeters (useful anyway for COVID) as well as BP monitors, or would that just add to anxiety?

[Kaz747 in reply to Buffafly]

I’ve had a BP machine for years and bought an Oxometer for our “Covid Kit”. My husband and mother have lung disease and my daughter has asthma so I thought it could be a useful purchase.

And I often think we patients know a lot more than the junior doctors and some GPs when it comes to AF.

[BobD Volunteer in reply to Buffafly]

Another thing to worry about. I have one and seldom see higher than 95-97% and different in both hands due no doubt to damaged artery in right wrist from an angiogram in 2017.

[CDreamer in reply to BobD]

I don’t know Bob but that sounds excellent to me - my O2 says only ever stayed over 97 for 24 hours after HBOT. My average is 95, rarely exceeds 97 and at night dips to 88 and occasionally lower. Pretty sure it’s because of low haemoglobin but can’t do much about that as it’s a side affect of other meds.

[BobD Volunteer in reply to CDreamer]

Just checked it at 88 but been up step ladder all afternoon fitting new guttering to the front of the bungalow. Probably the altitude.lol Only another 10 meters to go.

[Kaz747 in reply to BobD]

😂😂

[CDreamer in reply to BobD]

😊👋

[john-boy-92 in reply to BobD]

My GP told me that in an adult, an SpO2 of 92% is the knee point where it drops in almost a straight line. At the time mine was 76%; he told me to go straight to A&E where the respiratory "hot clInIc" would be waiting for me. An oximeter is a useful thing to have at home, although I also have "white finger" on my right hand, that I usually forget to mention when I'm in hospital.

[Dawfor]

Many thanks for this. I became worried about my cognitive functioning a couple of years ago. An MRI showed a moderate amount of small vessel disease which was apparently more than normal for someone my age. A Neurology doctor thought it was probably due to micro emboli from my PAF and suggested I should be on an anticoagulant even though my ChadsVasc is only 1. However, the senior Consultant disagreed, said it wasn’t necessary and my Cardiologist went along with him saying it was a soft indication. I’m left hoping my apparently successful ablation last year will stop any further decline but am also left wondering if it was too little too late. Maybe the research will pave the way for an evidence based approach rather than being dependent on different medical opinions.

[Kaz747 in reply to Dawfor]

That’s very interesting Dawfor. My Chadvasc is 2 - one for being a woman (and some people say that shouldn’t be a full point) and the other point for having a history of high blood pressure, even though it’s perfect now (I had a hypertensive crisis 30 years ago when my first daughter was born).

My maternal grandmother had a number of strokes and my mother has dementia. I want to ensure I do everything I can to not take after either of them 😉🤪

[secondtry]

Thanks very much for posting on this unresolved issue. Anticoags may prove to help but I have also read (sorry to pour cold water on it) that they can cause those minute blood vessels in the brain to bleed - possibly causing cognitive decline or worse.

On a practical note, I have embraced the postponement of my retirement from work at 68 now believing it will slow the cognitive decline I have noticed e.g. typing errors, can't remember names more often and as you mentioned planning & taking the initiative is more laborious.......other than that life is very good!!!

[Kaz747 in reply to secondtry]

Thanks for that. I have brain fades at ti es - not sure if it’s menopause, aging or something else. I had guests for lunch on Friday. Instead of inviting them in to help themselves to some food, I said, “come in and get some money.” 😂😂😂 They were disappointed to find it was only chicken and salad.

Yep, gotta keep using the old grey matter. I don’t think I’ll ever really retire.

[secondtry in reply to Kaz747]

I am delighted to accept your invitation as a virtual friend...please send bitcoin!!

[Kaz747 in reply to secondtry]

😀 LOL

[terryw]

Hi Kaz747. I will be 80 years old in July. About three years ago I put myself into continuous AF because my quality of life in it was acceptable. I have not had a stroke. I am on Apixaban. I am slowing down, but the family still come to me for advice particularly on financial and legal matters. YOGA has proved beneficial to me especially the relaxation and breathing techniques. When I am out walking I keep an eye on my heart rate on the GPS and when it gets to 140 I take deeper breathes and I find that this lowers the pulse rate. The point I am trying to make is there may be increasing risks with AF, but there are things to do to reduce risk. For a start keep the brain and body active. I am on the way out but I am going with guns blazing and disgracefully! If you have forgotten something but cannot remember what it is you do not have Dementia. If you cannot remember that you have forgotten… TerryW.

[Kaz747 in reply to terryw]

Love your style Terry! I’m hoping to be just like you when I get older.

Good on you for keeping so well.

Xx

[dmjtanner in reply to terryw]

Thanks terryw, your post was heartening! I also am a big proponent of yoga and mediation…and walking. Thank you!

[CDreamer in reply to terryw]

Way to go…

[mav7 in reply to terryw]

Great post, Terry !

As they say, if you forgot where you put your car keys that is not dementia, dementia is when you don't know what the car keys are for.

[john-boy-92 in reply to terryw]

Yoga is great for relaxation, bu.t head stands and inverted poses may be a risk. After a hard gym session I would wind down with a shoulder stand, candle, plough and so forth. Two days after a session I had a stroke. My excellent Neurology Consultant told me that she had treated someone who had a stroke during yoga. Her advice was no inverted postures other than legs up the wall pose: a prone pose rather than inverted. It makes sense, as the neck is under a lot of pressure during an inverted pose, and plaque could be dislodged in the carotid artery.

[Kaz747 in reply to john-boy-92]

That’s interesting. I can’t say I’ve done any head stands lately and I’ll make sure I don’t.

[terryw]

and I am still appreciative of women😇😄

[dmjtanner]

Thanks for this excellent summary. I usually am unable to open links posted on this forum so I really appreciate the time you took to summarize this so well.

[CDreamer]

Thanks Kaz - I’ve seen the results of mental decline in my husband and pretty sure it was due to micro clots forming after being in persistent AF for more than year. Old age has also to be a factor.

[Kaz747 in reply to CDreamer]

It’s sucks getting old …. But it beats the alternative 😉

[CDreamer in reply to Kaz747]

Have to hang on to that - at least when life continues to be meaningful. Personally I wouldn’t want life with advanced Dementia and would choose the alternative.

I think that a long life is not something to be celebrated but a life well lived is.

[Kaz747 in reply to CDreamer]

I totally agree.

[Susannz]

Statistics: unless there are actual numbers attached then percentages are pretty meaningless in assessing relative risk. If the actual number of people with AF who have a stroke whilst on anticoagulants is about 2 per hundred, than an increased risk of 67% for those who are not on anticoagulants equates to an extra 1 and a bit people per hundred. Percentages can be scary without the actual numbers being shown.

[Kaz747 in reply to Susannz]

As the old saying goes, there’s lies, damn lies and statistics! 😉 I don’t take much notice of headline stats. The underlying message is to be healthy to avoid complications for both the sake of your heart and your brain.