Fig.1.

Plausible mechanisms by which atrial fibrillation (AF) induces vascular dementia and Alzheimer’s disease (AD). AF causes cerebral infarction due to the embolic mechanism through thrombus formation within the heart chamber and can be a risk of vascular dementia (left cascade). Meanwhile, persistent AF may accelerate the three major pathological hallmarks of AD, namely senile plaques, amyloid angiopathy, and neurofibrillary tangles, through AF-associated cerebral hypoperfusion (right cascade). In addition, cerebral hypoperfusion can cause hypoperfusive vascular dementia. Although further research should be conducted to reach definitive conclusions, anticoagulation therapy may prevent vascular dementia, while rhythm/rate control may prevent AD. Since AD frequently coexists with cerebrovascular diseases (AD with CVD) in the elderly, and both dementing disorders may be induced by AF, optimal management of AF should be considered for prevention of the two major subtypes of dementia. Possible confounding pathologies that contribute to dementia in AF patients are not included in the figure for simplification (see text for details).