Grant: Project Grant

The objective of the BRAIN AF trial is to find a preventive treatment against cognitive decline in young patients suffering from atrial fibrillation. Cognitive impairment refers to a disturbance affecting cognitive functions, such as reasoning or memory. There is a progression in cognitive impairment that could be mild, moderate or severe (this is referred to as dementia). Unfortunately, no treatment has yet been shown to be effective for dementia. Therefore, prevention therapies are prioritized. Research has shown that the brain could be affected by multiple factors, internal (i.e., family history) or external (i.e., obesity and lack of exercise). In recent years, growing evidence has shown that atrial fibrillation (the most frequent arrhythmia in Canada) increases the risk of developing cognitive impairment especially in patients <75 years old. The main hypothesis is that the accumulation of tiny blood clots in the brain could affect cognition. Indeed, in atrial fibrillation, contractions of the upper parts of the heart (the atria) are irregular and rapid and can induce the formation of blood clots. If the blood enters the brain, it can cause a stroke (large blood clot) or silent cerebral ischemia (tiny blood clots). In the absence of risk factors other than atrial fibrillation, the medication to prevent clot formation (blood thinners) is recommended after the age of 65 years. We are performing a randomized clinical trial where patients are randomly assigned to receive either an anticoagulation therapy or standard of care (placebo in most of the patients or aspirin in patients with vascular disease). Our goal is determine whether this therapy improves cognitive functions. Yearly cognitive testing (by questionnaires) are planned. The BRAIN-AF study seeks to demonstrate whether anticoagulation therapy, started earlier in patients with atrial fibrillation, produces a protective effect and decreases brain damage and cognitive decline.