Department of Neurology, University Hospital Essen and University Duisburg-Essen, Germany.
Population Health Research Institute/McMaster University, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada.
J Am Coll Cardiol. 2019 Feb 12;73(5):612-619. doi: 10.1016/j.jacc.2018.10.077.
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.
许多血管危险因素和血管疾病导致认知障碍和痴呆。许多研究和注册研究表明，心房颤动（AF）与认知障碍、认知能力下降和痴呆有关。这对血管性痴呆和阿尔茨海默病都是如此。假设的多因素机制包括缺血性中风，包括显性和隐性、脑微梗死、脑出血和脑血流减少。许多回顾性观察性和前瞻性研究支持 AF 患者抗凝治疗可能降低认知能力下降和痴呆的风险。维生素 K 拮抗剂（如华法林）和直接口服抗凝剂都有这种作用。然而，基于随机试验，抗凝治疗是否能降低 AF 患者的认知能力下降和痴呆，这仍然没有得到证实。
