Beyond the beats: a systematic review of the underlying inflammatory pathways between atrial fibrillation and cognitive decline

Atrial fibrillation (AF) and cognitive decline represent significant health challenges with increasing prevalence and significant socioeconomic implications. Emerging evidence suggests a potential link between AF and cognitive decline, including dementia and Alzheimer’s disease, although the underlying mechanisms remain incompletely understood. Inflammation has emerged as a key mediator in cardiovascular and neurological diseases, encouraging an investigation into its role in the atrial fibrillation-cognition association. A systematic search of PubMed, Web of Science, and PsycInfo was conducted to identify relevant studies investigating possible inflammatory mechanisms bridging AF and cognitive decline. Studies were assessed for quality and relevance, and data were synthesized using a narrative approach. Five papers were included, with only two longitudinal studies. Inflammatory biomarkers emerged as significant factors associated with both AF and cognitive decline. Three studies revealed a correlation between high-sensitivity CRP (HS-CRP) levels and cognitive decline in patients with AF, AF patients with cerebral infarction, and elderly individuals with AF. However, conflicting results were observed, as one study did not identify any associations between cognitive decline and HS-CRP levels. The scientific literature on this topic is scarce, and the results of existing studies often lack consistency in their findings, highlighting the need for further research to better understand and prevent this significant health burden in patients with AF. So, the results of this study are expected to inform future research directions and cognitive decline risk stratification, guiding the development of targeted interventions aimed at preserving cognitive function and improving outcomes in patients with AF.