Atrial Fibrillation and the Risk of Early‐Onset Dementia: A Systematic Review and Meta‐Analysis

Abstract

Background Recent studies have identified an increased risk of dementia in patients with atrial fibrillation (AF). However, both AF and dementia usually manifest late in life. Few studies have investigated this association in adults with early‐onset dementia. The aim of this study was to investigate the relationship between AF and early‐onset dementia. Methods and Results We searched the PubMed/MEDLINE, Embase, and Scopus databases through April 15, 2022, for studies reporting on the association between AF and dementia in adults aged <70 years, without language restrictions. Two reviewers independently performed the study selection, assessed the risk of bias, and extracted the study data. We performed a meta‐analysis of early‐onset dementia risk according to occurrence of AF using a random‐effects model. We retrieved and screened 1006 potentially eligible studies. We examined the full text of 33 studies and selected the 6 studies that met our inclusion criteria. The pooled analysis of their results showed an increased risk of developing dementia in individuals with AF, with a summary relative risk of 1.50 (95% CI, 1.00–2.26) in patients aged <70 years, and 1.06 (95% CI, 0.55–2.06) in those aged <65 years. Conclusions In this systematic review and meta‐analysis, AF was a risk factor for dementia in adults aged <70 years, with an indication of a slight and statistically imprecise excess risk already at ages <65 years. Further research is needed to assess which characteristics of the arrhythmia and which mechanisms play a role in this relationship.

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

“…230 A third meta-analysis of 6 studies including ≈1.6 million individuals determined that the association of AF varied by age (RR, 1.06 [95% CI, 0.55–2.06] in those <65 years of age and RR, 1.50 [95% CI, 1.00–2.26] in those <70 years of age). 231…”

Outdoor Nighttime Light Exposure (Light Pollution) is Associated with Alzheimer’s Disease

“…Average nighttime light intensity was more strongly associated with AD prevalence than some diseases and conditions reported or suspected to be risk factors for AD including alcohol abuse (Andrews, Goate, and Anstey 2020; Anstey, Mack, and Cherbuin 2009; Wang et al 2023; Nallapu et al 2023), chronic kidney disease (Zhang et al 2020; Tang et al 2022), depression (Saiz-Vazquez et al 2021), heart failure (Qiu et al 2006; Cermakova et al 2015), and obesity (Alford et al 2018; Al-Kuraishy et al 2023). However, other covariates were more strongly associated with AD than average nighttime light intensity including atrial fibrillation (Giannone et al 2022), diabetes, hyperlipidemia, hypertension, and stoke. This finding is perhaps not surprising as the effects of nighttime light exposure would be expected to be more subtle than factors robustly associated with AD.…”

Mortality benefit with AF ablation: Impact of normal sinus rhythm seen in CABANA and EAST AFnet

“…It is of great concern the relatively higher risk of adverse effects in younger patients, including mortality and other mechanisms of increased risk of morbidity and mortality such as cognitive decline and dementia 2,9 . Of equal concern is that, despite improvements in awareness and detection of AF, improvements in therapies to lower risk of thromboembolism and the incidence and progression of coexistent cardiovascular diseases, and electronic medical support systems to improve use and understanding of clinical care pathways, a recent temporal analysis of the Framingham Heart Study over approximately 50 years found mortality rates have remained statistically similar since the 1970s (adjusted hazard ratios for all‐cause mortality between participants with and without AF were 1.9 (95% confidence interval: 1.7–2.2) in time period 1, 1.4 (1.3–1.6) in period 2, and 1.7 (1.5–2.0) in period 3 (Ptrend = 0.70) 10 .…”