Vitamin K Antagonists and Cognitive Decline in Older Adults: A 24-Month Follow-Up

Abstract

Vitamin K participates in brain physiology. This study aimed to determine whether using vitamin K antagonists (VKAs), which interfere with the vitamin K cycle, were (i) cross-sectionally associated with altered cognitive performance, and (ii) independent predictors of cognitive changes in older adults over 24 months. Information was collected on the use of VKAs (i.e., warfarin, acenocoumarol, and fluindione) among 378 geriatric outpatients (mean, 82.3 ± 5.6 years; 60.1% female). Global cognitive performance and executive functions were assessed with Mini-Mental State Examination (MMSE) and Frontal Assessment Battery (FAB) scores, respectively, at baseline and after 12 and 24 months of follow-up. Age, gender, body mass index, mean arterial pressure, disability, gait speed, comorbidities, atrial fibrillation, stroke, carotid artery stenosis, leukoaraiosis grade on computed tomography (CT) scan, psychoactive drugs, antidementia drugs, blood-thinning drugs (i.e., anticoagulants other than VKAs, antiplatelet medications), serum creatinine levels, and vitamin B12 concentrations were considered as potential confounders. Using VKAs was associated with lower (i.e., worse) FAB score at baseline (adjusted β = −2.1, p = 0.026), and with a decrease in FAB score after 24 months (adjusted β = −203.6%, p = 0.010), but not after 12 months (p = 0.659). Using VKAs was not associated with any change in MMSE score at baseline (p = 0.655), after 12 months (p = 0.603), or after 24 months (p = 0.201). In conclusion, we found more severe executive dysfunction at baseline and incident executive decline over 24 months among geriatric patients using VKAs, when compared with their counterparts.

The Relationships Between Vitamin K and Cognition: A Review of Current Evidence

“…The same author found an important decline in executive functions (assessed with frontal assessment battery) among geriatric patients treated with VKAs over at 24 months follow up. It's worth noticing how, in the same study, decline in Mini mental state examination (MMSE) scores, used as an assessment of cognitive performance, was not found significantly associated with VKAs use over the same period of time ( 72 ).…”

The Role of Vitamin K in Humans: Implication in Aging and Age-Associated Diseases

“…Increased VK intake was linked with fewer and less severe subjective memory disorders in participants taking no VK antagonists (VKAs) [183]. The use of VKAs as anticoagulant medications lowered the VK bioavailability, thus reducing the VK concentration and increasing the altered cognitive performance risk and the frequency of cognitive impairment in the elderly [184,185].…”

Atrial Fibrillation and Cognitive Impairment: An Associated Burden or Burden by Association?

“…Another study from the same group found more severe executive dysfunction at baseline and incident executive decline over 1 year among 46 geriatric patients using VKAs, when compared with their counterparts (n = 332). 124 Taking such findings into consideration, it is bestowed upon future comparative trials to explore for any differential effect of the newer NOACs on cognition in patients with AF. It should be noted that the latter 2 studies did not provide any data on TTR.…”