Abstract：
The aging population in Europe faces a substantial burden from dementia, with vascular cognitive impairment and dementia (VCID) being a preventable cause. Atrial fibrillation (AF), a common cardiac arrhythmia, increases the risk of VCID through mechanisms such as thromboembolism, cerebral hypoperfusion, and inflammation. This review explores the epidemiology, pathophysiology, and preventive strategies for AF-related VCID. Epidemiological data indicate that AF prevalence rises with age, affecting up to 12% of individuals over 80. Neuroimaging studies reveal chronic brain changes in AF patients, including strokes, lacunar strokes, white matter hyperintensities (WMHs), and cerebral microbleeds (CMHs), while cognitive assessments show impairments in memory, executive function, and attention. The COVID-19 pandemic has exacerbated the underdiagnosis of AF, leading to an increase in undiagnosed strokes and cognitive impairment. Many elderly individuals did not seek medical care due to fear of exposure, resulting in delayed diagnoses. Additionally, reduced family supervision during the pandemic contributed to missed opportunities for early detection of AF and related complications. Emerging evidence suggests that long COVID may also elevate the risk of AF, further complicating the management of this condition. This review underscores the importance of early detection and comprehensive management of AF to mitigate cognitive decline. Preventive measures, including public awareness campaigns, patient education, and the use of smart devices for early detection, are crucial. Anticoagulation therapy, rate and rhythm control, and addressing comorbid conditions are essential therapeutic strategies. Recognizing and addressing the cardiovascular and cognitive impacts of AF, especially in the context of the COVID-19 pandemic, is essential for advancing public health.
摘要：
欧洲的老龄化人口面临着严重的痴呆症负担，血管性认知障碍和痴呆（VCID）是可预防的原因。心房颤动(AF),常见的心律失常,通过血栓栓塞等机制增加VCID的风险，脑灌注不足,和炎症。这篇综述探讨了流行病学，病理生理学,房颤相关VCID的预防策略。流行病学数据表明房颤患病率随年龄增长而上升,影响高达12%的80岁以上的人。神经影像学研究揭示了房颤患者的慢性大脑变化，包括笔划,腔隙中风，白质高强度（WMHs），和脑微出血(CMHs)，虽然认知评估显示记忆受损，执行功能，和注意。COVID-19大流行加剧了房颤的诊断不足，导致未确诊的中风和认知障碍的增加。许多老年人由于害怕接触而没有寻求医疗护理，导致诊断延迟。此外,大流行期间家庭监护的减少导致错过了早期发现房颤和相关并发症的机会.新出现的证据表明，长期COVID也可能会增加房颤的风险，使这种情况的管理更加复杂。这篇综述强调了早期发现和全面管理房颤对减轻认知能力下降的重要性。预防措施,包括公众意识运动，患者教育,以及使用智能设备进行早期检测，是至关重要的。抗凝治疗,心率和节律控制，解决合并症是必不可少的治疗策略。认识并解决房颤对心血管和认知的影响，特别是在COVID-19大流行的背景下，对于促进公共卫生至关重要。
