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A trial fibrillation (AF) is the most common cardiac arrhythmia, and those afflicted have reduced quality of life, functional status, and cardiac performance. Patients with AF have a higher risk of stroke, heart failure, and premature death relative to patients without AF. It is estimated that 2.5% of the population worldwide has AF, and the prevalence of AF increases substantially with age, especially after 50 years of age. AF is more common among white persons than black persons, and men are at 1.5 times greater risk for developing AF than women. In the United States, about 2.3 million people currently have AF, and the numbers are increasing rapidly. It is predicted that by 2050, 5.6 million people in the United States will have AF, with more than half of those patients aged >80 years. This represents a 2.5-fold increase over 50 years, reflecting both the growing proportion of elderly persons in the population and the increasing rates of comorbidities associated with AF, including coronary artery disease, hypertension, and congestive heart failure. Although the prevalence of AF is increasing, cognitive disorders are also on the rise in tandem with the aging of the population. Patients with mild cognitive impairment have increased morbidity and lower quality of life relative to patients with normal cognitive function, and compared with those with normal cognition, patients with dementia have increased mortality. The diagnosis of mild cognitive impairment is made based on cognitive testing scores that are lower than expected for a patient’s age, typically due to memory, but these persons maintain independent functional status in terms of activities of daily living and instrumental activities of daily living. Patients are diagnosed with dementia when they have evidence of cognitive impairment on testing and this cognitive deficit affects their functional status. More than 20% of people aged >70 years have mild cognitive impairment. There are 800 000 cases of mild cognitive impairment and 560 000 cases of dementia annually in the United States, and patients who have progressed from mild cognitive impairment to dementia account for 75% of patients with dementia. The prevalence of dementia increases with age from about 5% of patients in their 70s to nearly 40% of patients in their 90s. The aging population is predicted to result in an increase in the prevalence of dementia such that >80 million people worldwide are expected to have dementia by 2040. Historically, patients were classified as having Alzheimer’s disease if they had neurodegenerative disease and vascular dementia or if they had cerebral vascular lesions. This was an oversimplification because most patients have a combination of neurodegenerative and vascular lesions contributing to the clinical phenotype of dementia. This review is intended to review the literature and present the current findings on the association between AF and cognitive decline. The focus is on whether evidence shows that AF is associated with cognitive impairment beyond the relationship with stroke.