Mechanisms and Clinical Manifestations of Cognitive Decline in Atrial Fibrillation Patients: Potential Implications for Preventing Dementia

Blum, Steffen; Conen, David

doi:10.1016/j.cjca.2022.10.013

Cited by 13 publications

(10 citation statements)

References 150 publications

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“…Both CImp and AF share several common risk factors, as they primarily affect the elderly population. Silent brain infarctions, and clinically apparent ischemic strokes are likely processes behind the elevated risk of CImp complicating AF in this age group 60,61 . Some studies suggest that anticoagulant therapy, including direct oral anticoagulants and vitamin K antagonists, may reduce the incidence of CImp and dementia in patients with AF.…”

Section: Discussionmentioning

confidence: 96%

“…Therefore, randomized trials 56 are still needed to provide conclusive evidence that anticoagulation reduces the risk of CImp and dementia in AF patients. Future research should also explore the potential advantages of increasing the use of oral anticoagulation or enhancing adherence to anticoagulant treatment in specific patient subgroups 61,63 .…”

Section: Discussionmentioning

confidence: 99%

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The Link Between Atrial Fibrillation And Cognitive Impairment: A Systematic Review And Meta-Analysis

Agarwal,

Mostafa,

Ahmad

et al. 2023

Preprint

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Atrial fibrillation (AF) affects a substantial population of individuals aged ≥55 years globally and has been associated with an increased risk of cognitive impairment (CImp) due to the shared risk factors such as aging, obesity, and diabetes. It is essential to comprehend their unique relationship to manage them effectively to reduce its impact on public health systems. We performed a PubMed search of English language papers published till 31 May 2023. Data was extracted and effect measures were calculated. Meta-analysis of 33 studies revealed a significant association between AF and CImp after adjusting for comorbidities, with considerable between-study heterogeneity (pooled OR: 1.62; 95% CI: 1.43, 1.81, I2 = 94.143). Prospective and cross-sectional studies revealed substantial associations. CImp in AF may be mediated through silent brain infarctions, microemboli, brain atrophy, and inflammation. Future research should prioritize investigating the mechanisms and etiology of this association, as well as potential treatment options.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

The Link Between Atrial Fibrillation And Cognitive Impairment: A Systematic Review And Meta-Analysis

Agarwal,

Mostafa,

Ahmad

et al. 2023

Preprint

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“…Dementia and atrial fibrillation (AF) shared various common risk factors, and the presence of AF increased risk of incident dementia via multiple different mechanisms. 1 While the most common cause of death in patients with dementia was cardiovascular related, 2 there are sparse report on the risks of incident AF, and the associated AF-related clinical outcomes in patients with dementia. In addition, those patients represented minor population in randomized trials.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Risk of Incident Atrial Fibrillation and Subsequent Use of Oral Anticoagulants in Patients with Dementia

Tsai,

Chan,

Liao

et al. 2023

Thromb Haemost

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Background: Dementia and atrial fibrillation (AF) have many shared risk factors. There are limited data on the risks of incident AF and AF-related clinical outcomes in patients with dementia. Methods: Out study utilized the Taiwan National Health Insurance Research Database. A total of 544,074 patients with dementia were compared to 554,074 age- and sex-matched patients without dementia regarding the risk of incident AF. Among patients with dementia who experienced incident AF, the risks of clinical events of patients treated with warfarin or NOACs were compared to those without OACs. Results: The risk of incident AF was greater for patients with dementia compared to those without (1.89 vs 1.78 per 100 person-years). Among patients with dementia and experienced incident AF, warfarin use was associated with a higher risk of ischemic stroke (aHR 1.290; 95%CI 1.156-1.440), intracranial hemorrhage (ICH)(aHR 1.678; 95%CI 1.346-2.090) and major bleeding (aHR 1.192; 95%CI 1.073-1.323) compared to non-OACs. NOAC use was associated with a lower risk of ischemic stroke (aHR 0.421; 95%CI 0.352-0.503) and composite risk of ischemic stroke or major bleeding (aHR 0.544; 95%CI 0.487-0.608) compared to non-OACs. These results were consistent among the patients after the propensity matching. Conclusions: In this nationwide cohort, the risk of incident AF was higher in patients with dementia. For patients with dementia who experienced incident AF, NOAC use was associated with better clinical outcomes compared to non-OAC. Patients with dementia require a holistic approach to their care and management, including the use of NOACs to reduce risks of clinical events.

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“…It is associated with an up to 2.4-fold increase in the risk of developing CD or even dementia [ 14 ]. Sometimes, AF is fortuitously diagnosed in patients with silent brain infarcts or those suffering an unexpected stroke, but in recent years, CD has also been encountered in patients with AF even without evidence of a stroke [ 15 ]. AF may favor the earlier onset of CD mainly by subclinical atherosclerosis in the cerebral small arteries, but cognitive impairment can also occur through brain hypoperfusion, a proinflammatory state, and microhemorrhages in patients treated with chronic anticoagulant therapy, thus leading to cerebral atrophy [ 3 , 16 , 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Connections between Cognitive Impairment and Atrial Fibrillation in Patients with Diabetes Mellitus Type 2

Militaru,

Lighezan,

Tudoran

et al. 2024

Biomedicines

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(1) Background: Cognitive decline (CD), considered a precursory state of dementia, is frequently encountered in patients with diabetes mellitus type 2 (DM-2) and might even have a higher prevalence in those with associated atrial fibrillation (AF). In this study, we aimed to research if the association of DM-2 and AF favors a precocious onset of CD. (2) Methods: This study was conducted on 160 patients, featuring 50 with DM-2, 54 with DM-2 and AF, and 56 subjects without DM-2 and AF, all evaluated clinically and with five neuropsychiatric scales. (3) Results: The Mini-Mental-State-Examination (MMSE), Montreal Cognitive Assessment (MoCA), Activities of Daily Living Score (ADL), Instrumental Activities of Daily Living Score (IADL), and Geriatric Depression Scale (GDS-15) were significantly altered in patients with DM-2 and AF in comparison to patients without these diseases. The logistic regression model indicated that, in patients with DM-2 and AF, an increase of one year in age is associated with a 7.3% augmentation of the risk of a precocious onset of CD (MMSE < 27). (4) Conclusions: CD is more frequent in patients with DM-2, especially when associated with AF, versus those without DM-2 and AF. Our findings suggest that an older age and associated dyslipidemia represent risk factors for CD in patients with DM-2.

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Mechanisms and Clinical Manifestations of Cognitive Decline in Atrial Fibrillation Patients: Potential Implications for Preventing Dementia

Cited by 13 publications

References 150 publications

The Link Between Atrial Fibrillation And Cognitive Impairment: A Systematic Review And Meta-Analysis

The Link Between Atrial Fibrillation And Cognitive Impairment: A Systematic Review And Meta-Analysis

Risk of Incident Atrial Fibrillation and Subsequent Use of Oral Anticoagulants in Patients with Dementia

Connections between Cognitive Impairment and Atrial Fibrillation in Patients with Diabetes Mellitus Type 2

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