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Dr. Douglas L. Packer, MD, FHRS, Mayo Clinic, Rochester, MN
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Faye Spencer, Boise, ID, April 2017
“I think your site has helped a lot of patients.”Dr. Hugh G. Calkins, MD Johns Hopkins,
Baltimore, MD
How Wide-Spread is Silent Brain Damage in A-Fib Patients?
A-Fib patients are at increased risk for cognitive problems and dementia, even in the absence of stroke. But why?
Swiss researchers devised a study to determine what causes A-Fib patients to experience more cognitive dysfunction.
Mechanisms of A-Fib Cognitive Decline
The Swiss-AF research is an observational study designed to identify the mechanisms of cognitive decline in A-Fib patients. The study enrolled A-Fib patients between 2014 and 2017 from 14 centers in Switzerland.
All patients had standardized brain magnetic resonance imaging (MRI). Analyzed were 1,389 A-Fib patients with no history of stroke or transient ischemic attack (TIA). The average age of the A-Fib patients was 72 years. Most (89%) were being treated with oral anticoagulants.
Study Findings: Types of Silent Brain Damage
The MRI scans showed that 569 (41%) had at least one type of previously unknown (silent) brain damage.
• 15% (207) had a cerebral infarct (dead tissue resulting from a failure of blood supply)
• 19% (269) had small bleeds in the brain (microbleeds)
• 16% (222) had small brain lesions
Oral Anticoagulants and Silent Brain Damage: In this study the researchers couldn’t determine if the cerebral infarcts and other brain lesions occurred before or after patients started taking oral anticoagulants. But the researchers did state:
“The findings nevertheless raise the issue that oral anticoagulation might not prevent all brain damage in patients with atrial fibrillation.”
Additional analysis incomplete: The patients in this study underwent extensive cognitive testing to determine if patients with silent brain damage also have impaired cognitive function. But this analysis hasn’t been completed.
What A-Fib Patients Need to Know
The Swiss-AF research was a small study in one country over four years with 1,389 A-Fib patients. The risk of silent brain damage was found in 4 of 10 A-Fib patients. But the findings are alarming and worth continued research.
For A-Fib patients these findings can be frightening―especially for older patients. On top of that, it’s likely further analysis will show ‘cognitive decline’ as well in patients with these types of brain damage.
So, what can you do?
• Aim to get cured of A-Fib as soon as practical, such as by a catheter ablation. (Don’t let anyone tell you that you’re too old to have an ablation. People in their 90s have successful ablations.)
• Seek ways to avoid taking oral anticoagulants, if possible. Intuitively one suspects that anything that causes or increases bleeding in the brain like anticoagulants can be risky and dangerous for older patients. Consider installing a device to close off the Left Atrial Appendage (LAA) where 90%-95% of A-Fib clots originate.
Learn More About Risks for Cognitive Problems and Dementia
To learn more about how A-Fib patients are at increased risk for cognitive problems and dementia, see my articles: Anticoagulants, Dementia and Atrial Fibrillation and Increased Dementia Risk Caused by A-Fib: 20 Year Study Findings.
Also see my answer to this FAQ: “I’m scared of getting dementia. Can the right minerals help? I’ve read about the link with A-Fib. What does research reveal about this risk?”
