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Neurology. 2018 Nov 6;91(19):e1732-e1740. doi: 10.1212/WNL.0000000000006456. Epub 2018 Oct 10.

Atrial fibrillation, antithrombotic treatment, and cognitive aging: A population-based study.

Author information

1
From the Aging Research Center (M.D., L.F., K.J., G.S., J.F., A.M., C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University; Stockholm Gerontology Research Center (L.F.), Stockholm; Institute of Environmental Medicine (P.L.), Karolinska Institutet, Stockholm; Department of Cardiology (P.L.), Danderyd Hospital, Stockholm, Sweden; and Department of Clinical and Experimental Sciences (A.M.), University of Brescia, Italy. mozhu.ding@ki.se.
2
From the Aging Research Center (M.D., L.F., K.J., G.S., J.F., A.M., C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University; Stockholm Gerontology Research Center (L.F.), Stockholm; Institute of Environmental Medicine (P.L.), Karolinska Institutet, Stockholm; Department of Cardiology (P.L.), Danderyd Hospital, Stockholm, Sweden; and Department of Clinical and Experimental Sciences (A.M.), University of Brescia, Italy.

Abstract

OBJECTIVE:

To examine the association of atrial fibrillation (AF) with cognitive decline and dementia in old age, and to explore the cognitive benefit of antithrombotic treatment in patients with AF.

METHODS:

This population-based cohort study included 2,685 dementia-free participants from the Swedish National Study on Aging and Care in Kungsholmen, who were regularly examined from 2001-2004 to 2010-2013. AF was ascertained from clinical examination, ECG, and patient registry. Global cognitive function was assessed using the Mini-Mental State Examination. We followed the DSM-IV criteria for the diagnosis of dementia, the NINDS-AIREN (National Institute of Neurological Disorders and Stroke and Association Internationale pour la Recherché et l'Enseignement en Neurosciences) criteria for vascular dementia, and the NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association) criteria for Alzheimer disease. Data were analyzed using multiple linear mixed-effects and Cox regression models.

RESULTS:

We identified 243 participants (9.1%) with AF at baseline. During the 9-year follow-up period, 279 participants (11.4%) developed AF and 399 (14.9%) developed dementia. As a time-varying variable, AF was significantly associated with a faster annual Mini-Mental State Examination decline (β coefficient = -0.24, 95% confidence interval [CI]: -0.31 to -0.16) and an increased hazard ratio (HR) of all-cause dementia (HR = 1.40, 95% CI: 1.11-1.77) and vascular and mixed dementia (HR = 1.88, 95% CI: 1.09-3.23), but not Alzheimer disease (HR = 1.33, 95% CI: 0.92-1.94). Among people with either prevalent or incident AF, use of anticoagulant drugs, but not antiplatelet treatment, was associated with a 60% decreased risk of dementia (HR = 0.40, 95% CI: 0.18-0.92).

CONCLUSION:

AF is associated with a faster global cognitive decline and an increased risk of dementia in older people. Use of anticoagulant drugs may reduce dementia risk in patients with AF.

PMID:
30305443
PMCID:
PMC6251601
DOI:
10.1212/WNL.0000000000006456
[Indexed for MEDLINE]
Free PMC Article

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