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Incident AF increases risk for dementia in older patients
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Older patients with incident atrial fibrillation had an increased risk for dementia independent of clinical stroke, according to a study published in the European Heart Journal.
“Our study suggests that the strong link between atrial fibrillation and dementia could be weakened if patients took oral anticoagulants,” Gregory Y.H. Lip, MD, FRCP, DFM, FACC, FESC, professor of cardiovascular medicine at the University of Liverpool and an adjunct professor at Yonsei University College of Medicine in Seoul, South Korea, said in a press release. “Therefore, doctors should think carefully and be readier to prescribe anticoagulants for atrial fibrillation patients to try to prevent dementia.”
Dongmin Kim, MD, resident in the department of emergency medicine at Dankook University in Yongin, Korea, and colleagues analyzed data from 262,611 patients from the National Health Insurance Service senior cohort who were aged at least 60 years and were free from stroke, dementia and AF at baseline.
Dementia assessment was performed with the Korean Dementia Screening Questionnaire, which consisted of questions on instrumental activities of daily living and global memory function.
Of the patients in the study, 10,435 were diagnosed with incident AF during an observational period of 1,629,903 person-years.
The incidence of dementia was 4.1 per 100 person-years in patients with incident AF and 2.7 per 100 person-years in patients who were propensity score-matched and were free from AF. The risk for dementia was still significantly increased by incident AF after propensity score matching (HR = 1.52; 95% CI, 1.43-1.63) and after censoring for stroke (HR = 1.27; 95% CI, 1.18-1.37).
Incident AF increased the risk for vascular dementia (HR = 2.11; 95% CI, 1.85-2.41) and Alzheimer’s disease (HR = 1.31; 95% CI, 1.2-1.43).
Oral anticoagulant use in patients with incident AF had a preventive effect on the development of dementia (HR = 0.61; 95% CI, 0.54-0.68).
Every 1-point increase in the CHA2DS2-VASc score was linked to a higher risk for dementia (HR = 1.11; 95% CI, 1.07-1.14).
“Large longitudinal studies with longer follow-up time are needed to clarify the effect of [non-vitamin K oral anticoagulants] on cognitive function, and currently randomized controlled clinical trials focusing on cognitive outcomes in patients with AF have been initiated,” Kim and colleagues wrote. – by Darlene Dobkowski
Disclosures: Lip reports he is a consultant for Bayer/Janssen, Biotronik, Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, Daiichi-Sankyo, Medtronic and Microlife and a speaker for Bayer, Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, Daiichi-Sankyo, Medtronic, Microlife and Roche. Kim reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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