Atrial fibrillation is associated with cognitive impairment ranging from mild to overt dementia, and this association is independent of clinical stroke and multiple shared risk factors. Whether the use of the novel anticoagulants will offer greater protection than warfarin remains to be determined. Rate control strategies may improve brain perfusion and memory but this has not been studied in a randomized controlled trial. Overall, this is a novel field that requires multiple observational studies with long-term follow-up and large-scale randomized controlled trials with accurate neurocognitive testing and brain imaging to ultimately define effective preventive strategies and treatment options.