Author + information
- Received July 5, 2018
- Revision received October 14, 2018
- Accepted October 30, 2018
- Published online February 4, 2019.
- Hans-Christoph Diener, MD, PhDa,∗ (, )@unidue,
- Robert G. Hart, MDb,
- Peter J. Koudstaal, MDc,
- Deirdre A. Lane, PhDd and
- Gregory Y.H. Lip, MDd,e
- aDepartment of Neurology, University Hospital Essen and University Duisburg-Essen, Germany
- bPopulation Health Research Institute/McMaster University, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada
- cDepartment of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands
- dLiverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- eAalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- ↵∗Address for correspondence:
Dr. Hans-Christoph Diener, Department of Neurology, University Hospital Essen and University Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany.
Numerous vascular risk factors and vascular diseases contribute to cognitive impairment and dementia. Many studies and registries show an association of atrial fibrillation (AF) with cognitive impairment, cognitive decline, and dementia. This is true for vascular dementia and Alzheimer's disease. The assumed multifactorial mechanisms include ischemic stroke, both apparent and silent, cerebral microinfarcts, cerebral hemorrhage, and reduced cerebral blood flow. A number of retrospective observational and prospective studies support that anticoagulation in patients with AF may reduce the risk of cognitive decline and dementia. This holds for both vitamin K antagonists (e.g., warfarin) and direct oral anticoagulants. However, it still remains unproven if anticoagulation reduces cognitive decline and dementia in AF patients based on randomized trials.
Dr. Diener has received honoraria for participation in clinical trials, contribution to advisory boards, or oral presentations from Abbott, Achelios, Allergan, AstraZeneca, Bayer Vital, Bristol-Myers Squibb, Boehringer Ingelheim, CoAxia, Corimmun, Covidien, Daiichi-Sankyo, D-Pharm, Fresenius, GlaxoSmithKline, Janssen-Cilag, Johnson & Johnson, Knoll, Lilly, Merck Sharp & Dohme, Medtronic, MindFrame, Neurobiological Technologies, Novartis, Novo Nordisk, Paion, Parke-Davis, Pfizer, Portola, Sanofi, Schering Plough, Servier, Solvay, St. Jude, Syngis, Talecris, Thrombogenics, WebMD Global, and Wyeth; has received financial support for research projects from AstraZeneca, GlaxoSmithKline, Boehringer Ingelheim, Lundbeck, Novartis, Janssen-Cilag, Sanofi, Syngis, and Talecris; his institution, the Department of Neurology at the University Duisburg-Essen, has received research grants from the German Research Council, German Ministry of Education and Research, European Union, National Institutes of Health, Bertelsmann Foundation, and Heinz-Nixdorf Foundation; has served within the past year as editor of Neurology International Open, Aktuelle Neurologie, and Arzneimitteltherapie, as coeditor of Cephalalgia, and on the editorial board of Lancet Neurology, Current Neurology and Neuroscience Reports, European Neurology, and Cerebrovascular Disorders; has served as chair of the Treatment Guidelines Committee of the German Society of Neurology and contributed to the EHRA and ESC guidelines for the treatment of AF; and has no ownership interest and does not own stocks of any pharmaceutical company. Dr. Hart has received research support and stipends for research involving rivaroxaban and honoraria for service on advisory boards for Bayer AG. Dr. Koudstaal has received royalties for the textbook of Neurology, Bohn Stafleu, & Van Loghum; has not received personal honoraria for participation in clinical trials; as chairman of the European Atrial Fibrillation Trial; has received research grants from the Dutch Heart Foundation, Bayer, and Boehringer Ingelheim; his institution, the Department of Neurology, currently receives research grants from the Dutch Heart Foundation, Dutch Brain Foundation, Dutch Ministry of Health, Stryker Neurovascular, Penumbra, Johnson and Johnson, and Covidien for the CONTRAST consortium that coordinates several trials on endovascular treatment of acute stroke; has served as investigator of the Rotterdam study for over 25 years, which is supported by several nonpharmaceutical grants; and does not own stocks of any pharmaceutical company. Dr. Lane has received educational grants from Bristol-Myers Squibb and Boehringer Ingelheim; has performed speaker activity for Pfizer; and has served as a consultant for Bristol-Myers Squibb, Bayer, Boehringer Ingelheim, and Daiichi-Sankyo. Dr. Lip has served as a consultant for Bayer/Janssen, Bristol-Myers Squibb/Pfizer, Medtronic, Boehringer Ingelheim, Novartis, Verseon, and Daiichi-Sankyo; and has served as a speaker for Bayer, Bristol-Myers Squibb/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo (no fees are directly received by him personally).
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received July 5, 2018.
- Revision received October 14, 2018.
- Accepted October 30, 2018.
- 2019 American College of Cardiology Foundation
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