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Atrial fibrillation (AF) is associated with an increased risk of dementia andcognitive decline, independent of strokes. Several mechanisms have beenproposed to explain this association, but altered cerebral blood flow dynamicsduring AF has been poorly investigated: in particular, it is unknown how AFinfluences hemodynamic parameters of the distal cerebral circulation, at thearteriolar and capillary level. Two coupled lumped-parameter models (systemicand cerebrovascular circulations, respectively) were here used to simulatesinus rhythm (SR) and AF. For each simulation 5000 cardiac cycles were analyzedand cerebral hemodynamic parameters were calculated. With respect to SR, AFtriggered a higher variability of the cerebral hemodynamic variables whichincreases proceeding towards the distal circulation, reaching the maximumextent at the arteriolar and capillary levels. This variability led to criticalcerebral hemodynamic events of excessive pressure or reduced blood flow: 303hypoperfusions occurred at the arteriolar level, while 387 hypertensive eventsoccurred at the capillary level during AF. By contrast, neither hypoperfusionsnor hypertensive events occurred during SR. Thus, the impact of AF per se oncerebral hemodynamics candidates as a relevant mechanism into the genesis ofAF-related cognitive impairment/dementia.

Transient cerebral hypoperfusion and hypertensive events during atrial fibrillation: a plausible mechanism for cognitive impairment