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Table III. The Rapid Cognitive Screen for mild cognitive impairment

Recall: Five objects?Apple, pen, tie, house, car. [Recall objects after clock drawing; 5 points.] Clock drawing: Draw with time at 10 minutes to 11 o'clock. [4 points] Insight: Jill was a very successful stockbroker. She made a lot of money on the stock market. She then met Jack, a devastatingly handsome man. She married him and had 3 children. They lived in Chicago. She then stopped work and stayed at home to bring up her children. When they were teenagers, she went back to work. She and Jack lived happily ever after. What country did they live in? [1 point]

0?5, dementia; 6?7, MCI; 8?10, normal.

At present, the best treatment to prevent progression of AF-associated cognitive impairment is unknown. As discussed previously, the available data on the benefit of warfarin are controversial. There are no studies examining the effects of the novel oral anticoagulants (dabigatran, rivaroxaban, and apixaban) on cognitive function. As noted, a small study by Efimova et al[66] demonstrated improved cognitive function and cerebral perfusion with improved control of ventricular rates during AF. Of note, a recent observational study of 4,212 people with AF who underwent PVI, after 3-year follow-up, demonstrated a significantly decreased incidence of dementia.[86] However, evidence suggesting PVI is associated with ischemic brain lesions and short-term decline in cognitive function raises concerns. Furthermore, long-term studies are needed to determine if strict rate control or rhythm control can prevent progression of AF-associated cognitive impairment.

In conclusion, we advocate all persons with AF be screened for cognitive dysfunction and all patients with cognitive dysfunction be screened for AF. There is a need for a large multicenter study to examine the effects of novel oral anticoagulants, rhythm and rate control, and left atrial appendage occlusion on long-term cognitive function. Moreover, end points of any future study designed to decrease stroke in AF patients should include other aspects of cognitive decline.

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Acknowledgements

No extramural funding was used to support this work. The authors are solely responsible for the design and conduct of this review.

Am Heart J. 2015;169(4):448-456. ? 2015 Mosby, Inc.

Copyright ? Mosby-Year Book, Inc. All rights reserved.

 

Date: 2016-06-13; view: 6

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