Atrial fibrillation increases the risk of dementia amongst older adults even in the absence of stroke

Abstract

Atrial fibrillation increases the risk of dementia amongst older adults even in the absence of stroke. J Intern Med 2019; 286: 101-110.Background. Atrial fibrillation increases risk of stroke, and thus risk of cognitive impairment and dementia. Emerging evidence suggests an association also in the absence of stroke. We aimed to examine the association between atrial fibrillation and incident dementia, with and without exclusion of individuals with stroke, and if sex and genetic factors modify the possible association.Methods. In 2000-2001, a population-based sample of 70-year-olds (N = 561) underwent comprehensive somatic and neuropsychiatric examinations, as part of the Gothenburg H70 Birth Cohort Studies. Participants were followed up at age 75 and 79. Atrial fibrillation at baseline was identified through ECG, proxy-reports and the National Patient Register (NPR). Stroke at baseline and follow-up was identified through self-reports, proxy-reports and the NPR. Dementia at baseline and follow-up was diagnosed according to the DSM-III-R criteria based on neuropsychiatric examinations, proxy-reports and the NPR.Results. Individuals with atrial fibrillation had an almost threefold increased risk of dementia during 12-year follow-up (HR 2.8; 95% CI 1.3-5.7; P = 0.004), and this risk remained after excluding individuals with stroke at baseline and follow-up. After stratification for sex, the association was only found amongst men (HR 4.6; 95% CI 1.9-11.2; P < 0.001, interaction sex*atrial fibrillation; P = 0.047) and noncarriers of the APOE e4 allele (HR 4.2; 95% CI 1.8-9.7; P < 0.001, interaction APOE*atrial fibrillation; P = 0.128). Population attributable risk for dementia resulting from atrial fibrillation was 13%.Conclusion. The relevance for atrial fibrillation as an indicator of subclinical brain vascular risk needs to be further explored. In addition, patients with atrial fibrillation should be screened for cognitive symptoms.

Re-thinking the Etiological Framework of Neurodegeneration

“…de Bruijn et al (2015) analyzed the association of prevalent and incident AF with incident dementia in 6514 dementia-free patients, revealing not only a positive association between AF and the development of dementia but also that the association was strongest for younger participants with the longest duration of AF. These findings have been replicated by several studies (Nishtala et al, 2018), some of which have shown that the association between AF and dementia is independent of the occurrence of embolic stroke (Ryden et al, 2019) and the use of anticoagulants (Graves et al, 2017). Future investigation will determine if optimal treatment of AF can prevent or postpone cognitive decline and dementia.…”

One‐year clinical outcomes of anticoagulation therapy among Japanese patients with atrial fibrillation: The Hyogo AF Network (HAF‐NET) Registry

“…The population attributable risk for dementia resulting from AF was 13%. They concluded that patients with AF should be screened for cognitive symptoms . In the HAF‐NET registry, dementia diagnosed before enrollment was found in 56 (2.7%) of the patients and the incidence of new onset dementia was 8 (0.4%) patients.…”

“…They concluded that patients with AF should be screened for cognitive symptoms. 28 In the HAF-NET registry, dementia diagnosed before enrollment was found in 56 (2.7%) of the patients and the incidence of new onset dementia was 8 (0.4%) patients. This annulus incidence of dementia was similar to that in patients without AF.…”

How to maintain an adherence to oral anticoagulant in a patient with atrial fibrillation?

“…ФП независимо повышает риск когнитивных нарушений / деменции по сравнению с синусовым ритмом, а среди предполагаемых механизмов ее негативного действия упоминают ишемический инсульт (с клиническими проявлениями и без них), бессимптомную церебральную ишемию вследствие субклинической микроэмболии, кровоизлияние в мозг, транзиторные критические расстройства гемодинамики, приводящие к гипоперфузии головного мозга, воспаление, генетические факторы [41,42]. Сообщалось о почти трехкратном повышении частоты развития деменции в течение 12 лет у больных с ФП (ОР 2,8 при 95 % ДИ от 1,3 до 5,7; р=0,004), причем ее риск сохранялся после исключения лиц с инсультом, развивавшимся до включения в исследование и в ходе последующего наблюдения [43].…”