Parfenov VA. Cognitive disorders in patients with atrial fibrillation: A review. Consilium Medicum. 2023;25(2):81–85. DOI: 10.26442/20751753.2023.2.202220
Когнитивные нарушения у пациентов с фибрилляцией предсердий
Парфенов В.А. Когнитивные нарушения у пациентов с фибрилляцией предсердий. Consilium Medicum. 2023;25(2):81–85. DOI: 10.26442/20751753.2023.2.202220
Parfenov VA. Cognitive disorders in patients with atrial fibrillation: A review. Consilium Medicum. 2023;25(2):81–85. DOI: 10.26442/20751753.2023.2.202220
Когнитивные нарушения (КН) представляют одну из ведущих причин инвалидности среди людей пожилого возраста. Фибрилляция предсердий (ФП) – независимый и корригируемый фактор риска КН и деменции. Развитие КН при ФП связано с возникновением клинически явных и немых церебральных инфарктов, церебральных микро- и макрокровоизлияний, сочетанной болезни мелких церебральных артерий, церебральной гипоперфузии, с сопутствующим нейродегенеративным заболеванием. Ведущее значение в предупреждении развития и прогрессирования КН у пациентов с ФП имеет профилактика первого и повторного ишемического инсульта, которая включает использование антагониста витамина К и новых оральных антикоагулянтов (НОАК – апиксабан, дабигатран, ривароксабан, эдоксабан), контроль артериального давления и другие методы профилактики. Применение НОАК более эффективно, чем использование антагониста витамина К, снижает риск развития КН и деменции. Обсуждаются вопросы применения отдельных НОАК, различные методы профилактики КН и болезни Альцгеймера у пациентов с ФП.
Cognitive disorders (CD) represent one of the leading causes of disability among the elderly. Atrial fibrillation (AF) is an independent and corrected risk factor for CD and dementia. The development of CD with AF is associated with the occurrence of cerebral infarcts, silent infarcts, cerebral micro and macro hemorrhages, a cerebral small vessels disease, cerebral hypoperfusion, and comorbid neurodegenerative disease. The prevention of the first and recurrent ischemic stroke (IS) is the leading importance in preventing the development and progression of the CD in AF, which include the use of the vitamin K antagonists (VKA) and new oral anticoagulants (the NOACs – apixaban, dabigatran, rivaroxaban, edoxaban), control of arterial pressure and other methods of prevention. The use of the NOACs is more effective than using VKA, reduces the risk of CD and dementia. The use of individual NOACs, various methods for the prevention of CD and Alzheimer's disease in patients with AF are discussed.
Keywords: atrial fibrillation, cognitive disorders, dementia, Alzheimer's disease, vascular dementia, new oral anticoagulants, apixaban, dabigatran, rivaroxaban, edoxaban, vitamin K antagonists
1. World Health Organization. Risk reduction of cognitive decline and dementia: WHO guidelines. Geneva: World Health Organization; 2019. Available at: https://www.who.int/publications/i/item/9789241550543. Accessed: 17.04.2023.
2. Goodman RA, Lochner KA, Thambisetty M, et al. Prevalence of dementia subtypes in United States Medicare fee-for-service beneficiaries, 2011–2013. Alzheimers Dement. 2017;13(1):28-37. DOI:10.1016/j.jalz.2016.04.002
3. van der Flier WM, Skoog I, Schneider JA, et al. Vascular cognitive impairment. Nat Rev Dis Primers. 2018;4:18003. DOI:10.1038/nrdp.2018.3
4. Diener HC, Hart RG, Koudstaal PJ, et al. Atrial fibrillation and cognitive function: JACC review topic of the week. J Am Coll Cardiol. 2019;73:612-9.
5. Wong CX, Brown A, Tse HF, et al. Epidemiology of atrial fibrillation: the Australian and Asia-Pacific perspective. Heart Lung Circ. 2017;26(9):870-9.
6. Ponjoan A, Garre-Olmo J, Blanch J, et al. Epidemiology of dementia: prevalence and incidence estimates using validated electronic health records from primary care. Clin Epidemiol. 2019;11:217-28.
7. Ott A, Breteler MM, de Bruyne MC, et al. Atrial fibrillation and dementia in a population-based study. The Rotterdam Study. Stroke. 1997;28:316-21.
8. Singh-Manoux A, Fayosse A, Sabia S, et al. Atrial fibrillation as a risk factor for cognitive decline and dementia. Eur Heart J. 2017;38:2612-8.
9. Kühne M, Krisai P, Coslovsky M, et al. Silent brain infarcts impact on cognitive function in atrial fibrillation. Eur Heart J. 2022;43:2127-35.
10. Papanastasiou CA, Theochari CA, Zareifopoulos N, et al. Atrial Fibrillation Is Associated with Cognitive Impairment, All-Cause Dementia, Vascular Dementia, and Alzheimer's Disease: a Systematic Review and Meta-Analysis. J Gen Intern Med. 2021;36(10):3122-35. DOI:10.1007/s11606-021-06954-8
11. Koh YH, Lew LZW, Franke KB, et al. Predictive role of atrial fibrillation in cognitive decline: a systematic review and meta-analysis of 2.8 million individuals. Europace. 2022;24(8):1229-39. DOI:10.1093/europace/euac003
12. Bunch TJ, Crandall BG, Weiss JP, et al. Patients treated with catheter ablation for atrial fibrillation have long-term rates of death, stroke, and dementia similar to patients without atrial fibrillation. J Cardiovasc Electrophysiol. 2011;22(8):839-45.
13. Cacciatore F, Testa G, Langellotto A, et al. Role of ventricular rate response on dementia in cognitively impaired elderly subjects with atrial fibrillation: a 10-year study. Dement Geriatr Cogn Disord. 2012;34(3-4):143-8.
14. Wardlaw JM, Smith C, Dichgans M. Small vessel disease: mechanisms and clinical implications. Lancet Neurol. 2019;18(7):684-96. DOI:10.1016/S1474-4422(19)30079-1
15. Кулеш А.А., Дробаха В.Е., Шестаков В.В. Церебральная болезнь мелких сосудов: классификация, клинические проявления, диагностика и особенности лечения. Неврология, нейропсихиа т рия, психосоматика. 2019;11(3S):4-17 [Kulesh AA, Drobakha VE, Shestakov VV. Cerebral small vessel disease: classification, clinical manifestations, diagnosis, and features of treatment. Neurology, Neuropsychiatry, Psychosomatics. 2019;11(3S):4-17 (in Russian)]. DOI:10.14412/2074-2711-2019-3S-4-17
16. Donnellan C, Werring D. Cognitive impairment before and after intracerebral haemorrhage: a systematic review. Neurol Sci. 2020;41(3):509-27. DOI:10.1007/s10072-019-04150-5
17. Iadecola C, Duering M, Hachinski V et al. Vascular Cognitive Impairment and Dementia: JACC Scientific Expert Panel. J Am Coll Cardiol. 2019;73(25):3326-44. DOI:10.1016/j.jacc.2019.04.034
18. Casolla B, Caparros F, Cordonnier C, et al. Biological and imaging predictors of cognitive impairment after stroke: a systematic review. J Neurol. 2019;266(11):2593-604. DOI:10.1007/s00415-018-9089-z
19. Levine DA, Galecki AT, Langa KM, et al. Trajectory of cognitive decline after incident stroke. JAMA. 2015;314:41-51. DOI:10.1001/jama.2015.6968
20. Pendlebury ST, Rothwell PM; Oxford Vascular Study. Incidence and prevalence of dementia associated with transient ischaemic attack and stroke: analysis of the population-based Oxford Vascular Study. Lancet Neurol. 2019;18(3):248-58. DOI:10.1016/S1474-4422(18)30442-3
21. Connolly S, Ezekowitz MD, Ysuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361:1139-51.
22. Patel МR, Mahaffey KW, Garg J, et al. Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation. N Engl J Med. 2011;365:883-91.
23. Granger CB, Alexander JH, McMurray JJV, et al. Apixaban versus Warfarin in Patients with Atrial Fibrillation. N Engl J Med. 2011;365:981-92.
24. Giugliano RP, Ruff CT, Braunwald E, et al. Edoxaban versus Warfarin in Patients with Atrial Fibrillation. N Engl J Med. 2013;369:2093-104.
25. Connolly SJ, Eikelboom J, Joyneret C, et al. Apixaban in patients with atrial fibrillation. N Engl J Med. 2011;364:806-17.
26. Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association. Stroke. 2021;52(7):e364-467. DOI:10.1161/STR.0000000000000375
27. Kimura S, Toyoda K, Yoshimura S, et al. SAMURAI, RELAXED, RAF, RAF-NOAC, CROMIS-2, NOACISP LONGTERM, Erlangen Registry and Verona Registry Investigators. Practical “1-2-3-4-Day” Rule for Starting Direct Oral Anticoagulants After Ischemic Stroke With Atrial Fibrillation: Combined Hospital-Based Cohort Study. Stroke. 2022:STROKEAHA121036695. DOI:10.1161/STROKEAHA.121.036695
28. Oldgren J, Åsberg S, Hijazi Z, et al. Early Versus Delayed Non-Vitamin K Antagonist Oral Anticoagulant Therapy After Acute Ischemic Stroke in Atrial Fibrillation (TIMING): A Registry-Based Randomized Controlled Noninferiority Study. Circulation. 2022;146(14):1056-66. DOI:10.1161/CIRCULATIONAHA.122.060666
29. Muscari A, Faccioli L, Lega MV, et al. Predicting hemorrhagic transformation and its timing from maximum cerebral lesion diameter in nonlacunar ischemic strokes. Brain Behav. 2020;10(1):e01497. DOI:10.1002/brb3.1497
30. Amin A, Keshishian A, Dina O, et al. Comparative clinical outcomes between direct oral anticoagulants and warfarin among elderly patients with non-valvular atrial fibrillation in the CMS medicare population. J Thromb Thrombolysis. 2019;48(2):240-9. DOI:10.1007/s11239-019-01838-5
31. Esteve-Pastor MA, Rivera-Caravaca JM, Roldán V, et al. Estimated Effectiveness and Safety of Nonvitamin K Antagonist Oral Anticoagulants Compared With Optimally Acenocoumarol Anticoagulated “Real-World” in Patients With Atrial Fibrillation. Am J Cardiol. 2018;122(5):785-92. DOI:10.1016/j.amjcard.2018.05.012
32. Кулеш А.А., Демин Д.А. Вопросы совершенствования ведения пациентов, перенесших ишемический инсульт на фоне фибрилляции предсердий. Неврология, нейропсихиатрия, психосоматика. 2022;14(6):115-21 [Kulesh AA, Demin DA. Issues of improving the management of patients with ischemic stroke on the background of atrial fibrillation. Neurology, Neuropsychiatry, Psychosomatics. 2022;14(6):115-21 (in Russian)]. DOI:10.14412/2074-2711-2022-6-115-121
33. Mongkhon P, Naser AY, Fanning L, et al. Oral anticoagulants and risk of dementia: a systematic review and meta-analysis of observational studies and randomized controlled trials. Neurosci Biobehav Rev. 2019;96:1-9.
34. Kim D, Yang PS, Jang E, et al. Association of anticoagulant therapy with risk of dementia among patients with atrial fibrillation. Europace. 2021;23(2):184-95. DOI:10.1093/europace/euaa192
35. Grymonprez M, Petrovic M, De Backer TL, et al. Comparing the risk of dementia in subjects with atrial fibrillation using non-vitamin K antagonist oral anticoagulants versus vitamin K antagonists: a Belgian nationwide cohort study. Age Ageing. 2023;52(3):afad038. DOI:10.1093/ageing/afad038
36. Парфенов В.А. Сосудистые когнитивные нарушения и хроническая ишемия головного мозга (дисциркуляторная энцефалопатия). Неврология, нейропсихиатрия, психосоматика. 2019;11(3S):61-7 [Parfenov VA. Vascular cognitive impairment and chronic cerebral ischemia (dyscirculatory encephalopathy). Neurology, Neuropsychiatry, Psychosomatics. 2019;11(3S):61-7 (in Russian)]. DOI:10.14412/2074-2711-2019-3S-61-67
37. Yu JT, Xu W, Tan CC, et al. Evidence-based prevention of Alzheimer's disease: systematic review and meta-analysis of 243 observational prospective studies and 153 randomised controlled trials. J Neurol Neurosurg Psychiatry. 2020;91(11):1201-9. DOI:10.1136/jnnp-2019-321913
________________________________________________
1. World Health Organization. Risk reduction of cognitive decline and dementia: WHO guidelines. Geneva: World Health Organization; 2019. Available at: https://www.who.int/publications/i/item/9789241550543. Accessed: 17.04.2023.
2. Goodman RA, Lochner KA, Thambisetty M, et al. Prevalence of dementia subtypes in United States Medicare fee-for-service beneficiaries, 2011–2013. Alzheimers Dement. 2017;13(1):28-37. DOI:10.1016/j.jalz.2016.04.002
3. van der Flier WM, Skoog I, Schneider JA, et al. Vascular cognitive impairment. Nat Rev Dis Primers. 2018;4:18003. DOI:10.1038/nrdp.2018.3
4. Diener HC, Hart RG, Koudstaal PJ, et al. Atrial fibrillation and cognitive function: JACC review topic of the week. J Am Coll Cardiol. 2019;73:612-9.
5. Wong CX, Brown A, Tse HF, et al. Epidemiology of atrial fibrillation: the Australian and Asia-Pacific perspective. Heart Lung Circ. 2017;26(9):870-9.
6. Ponjoan A, Garre-Olmo J, Blanch J, et al. Epidemiology of dementia: prevalence and incidence estimates using validated electronic health records from primary care. Clin Epidemiol. 2019;11:217-28.
7. Ott A, Breteler MM, de Bruyne MC, et al. Atrial fibrillation and dementia in a population-based study. The Rotterdam Study. Stroke. 1997;28:316-21.
8. Singh-Manoux A, Fayosse A, Sabia S, et al. Atrial fibrillation as a risk factor for cognitive decline and dementia. Eur Heart J. 2017;38:2612-8.
9. Kühne M, Krisai P, Coslovsky M, et al. Silent brain infarcts impact on cognitive function in atrial fibrillation. Eur Heart J. 2022;43:2127-35.
10. Papanastasiou CA, Theochari CA, Zareifopoulos N, et al. Atrial Fibrillation Is Associated with Cognitive Impairment, All-Cause Dementia, Vascular Dementia, and Alzheimer's Disease: a Systematic Review and Meta-Analysis. J Gen Intern Med. 2021;36(10):3122-35. DOI:10.1007/s11606-021-06954-8
11. Koh YH, Lew LZW, Franke KB, et al. Predictive role of atrial fibrillation in cognitive decline: a systematic review and meta-analysis of 2.8 million individuals. Europace. 2022;24(8):1229-39. DOI:10.1093/europace/euac003
12. Bunch TJ, Crandall BG, Weiss JP, et al. Patients treated with catheter ablation for atrial fibrillation have long-term rates of death, stroke, and dementia similar to patients without atrial fibrillation. J Cardiovasc Electrophysiol. 2011;22(8):839-45.
13. Cacciatore F, Testa G, Langellotto A, et al. Role of ventricular rate response on dementia in cognitively impaired elderly subjects with atrial fibrillation: a 10-year study. Dement Geriatr Cogn Disord. 2012;34(3-4):143-8.
14. Wardlaw JM, Smith C, Dichgans M. Small vessel disease: mechanisms and clinical implications. Lancet Neurol. 2019;18(7):684-96. DOI:10.1016/S1474-4422(19)30079-1
15. Кулеш А.А., Дробаха В.Е., Шестаков В.В. Церебральная болезнь мелких сосудов: классификация, клинические проявления, диагностика и особенности лечения. Неврология, нейропсихиа т рия, психосоматика. 2019;11(3S):4-17 [Kulesh AA, Drobakha VE, Shestakov VV. Cerebral small vessel disease: classification, clinical manifestations, diagnosis, and features of treatment. Neurology, Neuropsychiatry, Psychosomatics. 2019;11(3S):4-17 (in Russian)]. DOI:10.14412/2074-2711-2019-3S-4-17
16. Donnellan C, Werring D. Cognitive impairment before and after intracerebral haemorrhage: a systematic review. Neurol Sci. 2020;41(3):509-27. DOI:10.1007/s10072-019-04150-5
17. Iadecola C, Duering M, Hachinski V et al. Vascular Cognitive Impairment and Dementia: JACC Scientific Expert Panel. J Am Coll Cardiol. 2019;73(25):3326-44. DOI:10.1016/j.jacc.2019.04.034
18. Casolla B, Caparros F, Cordonnier C, et al. Biological and imaging predictors of cognitive impairment after stroke: a systematic review. J Neurol. 2019;266(11):2593-604. DOI:10.1007/s00415-018-9089-z
19. Levine DA, Galecki AT, Langa KM, et al. Trajectory of cognitive decline after incident stroke. JAMA. 2015;314:41-51. DOI:10.1001/jama.2015.6968
20. Pendlebury ST, Rothwell PM; Oxford Vascular Study. Incidence and prevalence of dementia associated with transient ischaemic attack and stroke: analysis of the population-based Oxford Vascular Study. Lancet Neurol. 2019;18(3):248-58. DOI:10.1016/S1474-4422(18)30442-3
21. Connolly S, Ezekowitz MD, Ysuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361:1139-51.
22. Patel МR, Mahaffey KW, Garg J, et al. Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation. N Engl J Med. 2011;365:883-91.
23. Granger CB, Alexander JH, McMurray JJV, et al. Apixaban versus Warfarin in Patients with Atrial Fibrillation. N Engl J Med. 2011;365:981-92.
24. Giugliano RP, Ruff CT, Braunwald E, et al. Edoxaban versus Warfarin in Patients with Atrial Fibrillation. N Engl J Med. 2013;369:2093-104.
25. Connolly SJ, Eikelboom J, Joyneret C, et al. Apixaban in patients with atrial fibrillation. N Engl J Med. 2011;364:806-17.
26. Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association. Stroke. 2021;52(7):e364-467. DOI:10.1161/STR.0000000000000375
27. Kimura S, Toyoda K, Yoshimura S, et al. SAMURAI, RELAXED, RAF, RAF-NOAC, CROMIS-2, NOACISP LONGTERM, Erlangen Registry and Verona Registry Investigators. Practical “1-2-3-4-Day” Rule for Starting Direct Oral Anticoagulants After Ischemic Stroke With Atrial Fibrillation: Combined Hospital-Based Cohort Study. Stroke. 2022:STROKEAHA121036695. DOI:10.1161/STROKEAHA.121.036695
28. Oldgren J, Åsberg S, Hijazi Z, et al. Early Versus Delayed Non-Vitamin K Antagonist Oral Anticoagulant Therapy After Acute Ischemic Stroke in Atrial Fibrillation (TIMING): A Registry-Based Randomized Controlled Noninferiority Study. Circulation. 2022;146(14):1056-66. DOI:10.1161/CIRCULATIONAHA.122.060666
29. Muscari A, Faccioli L, Lega MV, et al. Predicting hemorrhagic transformation and its timing from maximum cerebral lesion diameter in nonlacunar ischemic strokes. Brain Behav. 2020;10(1):e01497. DOI:10.1002/brb3.1497
30. Amin A, Keshishian A, Dina O, et al. Comparative clinical outcomes between direct oral anticoagulants and warfarin among elderly patients with non-valvular atrial fibrillation in the CMS medicare population. J Thromb Thrombolysis. 2019;48(2):240-9. DOI:10.1007/s11239-019-01838-5
31. Esteve-Pastor MA, Rivera-Caravaca JM, Roldán V, et al. Estimated Effectiveness and Safety of Nonvitamin K Antagonist Oral Anticoagulants Compared With Optimally Acenocoumarol Anticoagulated “Real-World” in Patients With Atrial Fibrillation. Am J Cardiol. 2018;122(5):785-92. DOI:10.1016/j.amjcard.2018.05.012
32. Кулеш А.А., Демин Д.А. Вопросы совершенствования ведения пациентов, перенесших ишемический инсульт на фоне фибрилляции предсердий. Неврология, нейропсихиатрия, психосоматика. 2022;14(6):115-21 [Kulesh AA, Demin DA. Issues of improving the management of patients with ischemic stroke on the background of atrial fibrillation. Neurology, Neuropsychiatry, Psychosomatics. 2022;14(6):115-21 (in Russian)]. DOI:10.14412/2074-2711-2022-6-115-121
33. Mongkhon P, Naser AY, Fanning L, et al. Oral anticoagulants and risk of dementia: a systematic review and meta-analysis of observational studies and randomized controlled trials. Neurosci Biobehav Rev. 2019;96:1-9.
34. Kim D, Yang PS, Jang E, et al. Association of anticoagulant therapy with risk of dementia among patients with atrial fibrillation. Europace. 2021;23(2):184-95. DOI:10.1093/europace/euaa192
35. Grymonprez M, Petrovic M, De Backer TL, et al. Comparing the risk of dementia in subjects with atrial fibrillation using non-vitamin K antagonist oral anticoagulants versus vitamin K antagonists: a Belgian nationwide cohort study. Age Ageing. 2023;52(3):afad038. DOI:10.1093/ageing/afad038
36. Парфенов В.А. Сосудистые когнитивные нарушения и хроническая ишемия головного мозга (дисциркуляторная энцефалопатия). Неврология, нейропсихиатрия, психосоматика. 2019;11(3S):61-7 [Parfenov VA. Vascular cognitive impairment and chronic cerebral ischemia (dyscirculatory encephalopathy). Neurology, Neuropsychiatry, Psychosomatics. 2019;11(3S):61-7 (in Russian)]. DOI:10.14412/2074-2711-2019-3S-61-67
37. Yu JT, Xu W, Tan CC, et al. Evidence-based prevention of Alzheimer's disease: systematic review and meta-analysis of 243 observational prospective studies and 153 randomised controlled trials. J Neurol Neurosurg Psychiatry. 2020;91(11):1201-9. DOI:10.1136/jnnp-2019-321913
Авторы
В.А. Парфенов*
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*vladimirparfenov@mail.ru
________________________________________________
Vladimir A. Parfenov*
Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*vladimirparfenov@mail.ru