Dr. John Day, Cardiologist

Is There Really a Link Between Atrial Fibrillation Onset Age and Future Dementia?

A study published this past week found that people who develop atrial fibrillation at a younger age are at increased risk of getting dementia later in life. Our research has shown that AFib doubles the risk of dementia but this is the first study to show that the earlier you get AFib the worse your dementia prognosis. Is this really the case and what can you do to protect your brain now?

The New Study: Age at Diagnosis of Atrial Fibrillation and Incident Dementia

This study, which looked at a large group of people over many years, used information from the UK Biobank, a public database in the UK. They collected baseline information from 2006 to 2010.

In their main analysis, they included 433,746 participants who didn’t have dementia or atrial fibrillation at baseline. They then followed these people for an average of 12.6 years to see who developed dementia and atrial fibrillation.

The study showed that being diagnosed with AFib at a younger age was directly linked to a greater chance of developing dementia. This risk was most significant for people diagnosed with AFib before turning 65 years old. The dementia risk was somewhat lower for those diagnosed with AFib between the ages of 65-74. And for those diagnosed with AFib at 75 or older, the dementia risk was the lowest.

Why Are AFib Patients at Increased Risk of Dementia?

The connection between atrial fibrillation and a higher risk of dementia is not completely clear, but there are several factors that seem to contribute:

1. Cerebral Microembolism:

AFib can cause blood clots in the heart, and these clots might travel to the brain, causing small blockages in blood vessels. These tiny blockages, or microemboli, can lead to small strokes, which may contribute to cognitive decline and a greater risk of dementia.

2. Reduced Blood Flow:

The irregular heartbeat in AFib can result in less efficient blood pumping, leading to lower blood flow to the brain. This reduced blood supply over time might contribute to the development of dementia.

3. Inflammation and Oxidative Stress:

AFib is associated with inflammation and oxidative stress, processes that can harm brain cells and contribute to neurodegeneration, which is linked to dementia.

4. Shared Risk Factors:

AFib and dementia share common risk factors like getting older, having high blood pressure, gaining weight, diabetes, and plaque build up in arteries. When these factors are present, it can increase the chances of both conditions happening at the same time.

5. Brain Changes:

AFib might be connected to changes in the structure of the brain, like the development of white matter lesions which can be seen on brain MRI studies. White matter lesions tend to occur in people with plaque build up in their arteries, high blood pressure, inflammation, poor lifestyles, or aging. In simpler terms, white matter lesions are like glitches in the brain’s communication network.

Why Might Younger AFib Patients Be at Higher Risk of Dementia?

While this study suggests that younger AFIb patients might be at higher risk for dementia, this is not yet proven. Younger individuals may have a longer time frame for the cumulative impact of risk factors associated with both AFib and dementia, such as high blood pressure, obesity, diabetes, and vascular diseases (plaque build up in the arteries). The combined effect of these risk factors over an extended period may increase the likelihood of developing dementia.

On the flip side, it could result directly from atrial fibrillation. Over time, the formation of tiny blood clots, or microclotting, may occur with AFib. The consistently irregular and rapid heart rate might of AFib might harm vulnerable brains over the decades. Another possibility is that it stems from reduced blood flow to the brain when in atrial fibrillation.

6 Ways to Protect the Brain from Atrial Fibrillation

Atrial fibrillation, the most common heart rhythm disorder, not only poses challenges to cardiovascular health but can also impact brain function. Here are 6 ways to protect the brain from AFib.

1. Maintain Normal Sinus Rhythm if Possible:

Whenever possible, normal sinus rhythm should be the goal. Treating atrial fibrillation (AFib) early increases the chances of putting it into remission. Sadly, a lot of our patients have been dealing with AFib for years before coming to us. In these cases, getting back to a normal heart rhythm might be difficult because the AFib has been happening for too long.

2. Take a Blood Thinner if Indicated:

Given that strokes, mini-strokes, or even asymptomatic microclotting can harm the brain over time in individuals with AFib, it’s crucial to consistently take any prescribed blood thinners. If you have AFib, discuss with your doctor to determine whether a blood thinner is recommended for you.

3. Religiously Adhere to a Heart Healthy Lifestyle:

Studies suggest that the majority of cases involving AFib and dementia can be averted by consistently adopting a heart-healthy lifestyle. This involves adhering strictly to a predominantly plant-based, unprocessed diet, maintaining a healthy weight, engaging in daily exercise to heal the brain, prioritizing adequate sleep, addressing sleep apnea if present, managing stress, giving importance to quality time with family and friends, and avoiding tobacco and alcohol.

4. Manage Risk Factors:

This involves monitoring your heart rhythm daily with a home ECG device for any indications of AFib, checking your blood pressure daily to ensure it remains at or below 120/80, tracking blood sugars regularly for those with diabetes to maintain normal levels, and consistently weighing yourself to sustain a healthy weight.

5. Mentally Stimulate Your Brain Daily:

To safeguard your brain from dementia, it’s essential to actively engage and stimulate it on a daily basis. The age-old saying “use it or lose it” rings true in this context. Participate in meaningful activities regularly that challenge and stimulate your brain, such as learning a new language or musical instrument. Maintain social connections to stay mentally active. Incorporate daily exercise into your routine to enhance blood flow and promote healing in the brain. Embrace the learning of new technologies to keep your mind sharp and adaptable.

6. Never Miss a Workout:

The importance of daily exercise cannot be overstated if your goal is to overcome AFib and reduce the risk of dementia. Physical activity boosts blood flow to the brain and elevates BDNF (brain-derived neurotrophic factors), encouraging the brain to heal and establish new electrical connections. Think of BDNF as fertilizer for your brain. Therefore, keep a record of your daily workouts, and if you’re using a smartwatch like the Apple Watch, set a goal to consistently complete your “exercise rings” each day.

The Good News from this Study

Although younger individuals with AFib seem to face an increased risk of dementia, the positive side is that treating AFib in younger patients is more straightforward. In fact, the younger you are, the higher the probability that our treatments will effectively maintain a normal sinus rhythm in your heart. Additionally, at a younger age, your body is more resilient, healing more rapidly from any damage that AFib may have already caused.

About the Photo

Accompanying this article is a snapshot from one of my routine mountain runs, a cherished activity shared with my daughter. Taken during a breathtaking fall run in Neff’s Canyon, outside of Salt Lake City, the photo captures the essence of our 100% commitment to daily exercise. This serene backdrop serves as a reminder of the positive impact that daily physical activity can have on our lives. The trails we traverse not only strengthen our bodies but also symbolize the proactive steps we take to reduce the risks of AFib and dementia.

Disclaimer

The information provided in this article is for educational and informational purposes only and is not intended as medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article. Reliance on any information provided in this article is solely at your own risk.