Anticoagulation in atrial fibrillation and cognitive decline

Zeng, Decai; Jiang, ChunLan; Su, Chunxiao; Tan, Yap‐Peng; Wu, Ji

doi:10.1097/md.0000000000014499

Cited by 24 publications

(30 citation statements)

References 39 publications

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“…In this sense, other studies carried out in hospitalized frail patients aged more than 75 years and nonagenarians found that anticoagulation was associated with low rates of stroke and bleeding, with a net benefit that was clearly superior to not being anticoagulated [30,31]. Moreover, anticoagulation has been associated with reduced cognitive impairment in patients with AF [32].…”

Section: Assessment Of the Risk Of Stroke And Bleeding In The Elderly Patientmentioning

confidence: 88%

The problem of underdosing with direct-acting oral anticoagulants in elderly patients with nonvalvular atrial fibrillation

2020

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Unless contraindicated, anticoagulant therapy should be prescribed to elderly patients with atrial fibrillation. Direct-acting oral anticoagulants (DOACs) are superior to vitamin K antagonists for preventing stroke. This, together with their higher net clinical benefit, makes DOACs the treatment of choice in this population. However, due to the concerns about bleeding and the need for dose adjustment based on clinical variables, underdosing of DOACs is common and the risk of stroke high. Drugs with more easily adjusted doses are likely associated with a lower risk of dosing errors and, therefore, a greater protective effect. Correct dosing can ensure a maximal net benefit of DOACs in elderly patients with atrial fibrillation.

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Section: Assessment Of the Risk Of Stroke And Bleeding In The Elderly Patientmentioning

confidence: 88%

The problem of underdosing with direct-acting oral anticoagulants in elderly patients with nonvalvular atrial fibrillation

2020

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“…From another study, the risk of cognitive decline appears to be stronger with earlier age of onset and longer duration of atrial fibrillation [54], but we did not have age of onset data to gauge whether participants in our cohorts had atrial fibrillation long enough to elicit statistically significant effects. We also did not have the data needed to consider the use of anticoagulants, which a recent meta-analysis found significantly reduced the effects of atrial fibrillation on cognitive decline [55].…”

Section: Discussionmentioning

confidence: 99%

Determinants of cognitive performance and decline in 20 diverse ethno-regional groups: A COSMIC collaboration cohort study

Lipnicki¹,

Makkar²,

Crawford³

et al. 2019

PLoS Med

107

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Background With no effective treatments for cognitive decline or dementia, improving the evidence base for modifiable risk factors is a research priority. This study investigated associations between risk factors and late-life cognitive decline on a global scale, including comparisons between ethno-regional groups. Methods and findings We harmonized longitudinal data from 20 population-based cohorts from 15 countries over 5 continents, including 48,522 individuals (58.4% women) aged 54-105 (mean = 72.7) years and without dementia at baseline. Studies had 2-15 years of follow-up. The risk factors investigated were age, sex, education, alcohol consumption, anxiety, apolipoprotein E ε4 allele (APOE*4) status, atrial fibrillation, blood pressure and pulse pressure, body mass index, cardiovascular disease, depression, diabetes, self-rated health, high cholesterol, hypertension, peripheral vascular disease, physical activity, smoking, and history of stroke. Associations with risk factors were determined for a global cognitive composite outcome (memory, language, processing speed, and executive functioning tests) and Mini-Mental State Examination score. Individual participant data meta-analyses of multivariable linear mixed model results pooled across cohorts revealed that for at least 1 cognitive outcome, age (B = −0.1, SE = 0.01), APOE*4 carriage (B = −0.31, SE = 0.11), depression (B = −0.11, SE = 0.06), diabetes (B = −0.23, SE = 0.10), current smoking (B = −0.20, SE = 0.08), and history of stroke (B = −0.22, SE = 0.09) were independently associated with poorer cognitive Determinants of cognition in diverse ethno-regional groups

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“…Despite the role of oral anticoagulants as first-line medication in the prevention of ischemic stroke in patients with AF [ 39 ], it is still debatable whether the risk of AF-related dementia can be significantly reduced by oral anticoagulation treatment [ 40 , 41 ]. Recent data suggest that the novel anticoagulants would be a better choice for the prevention of dementia than warfarin (a vitamin K antagonist) [ 42 , 43 ], probably due to a lower rate of intracerebral bleeding [ 43 ].…”

Section: Psychosocial Consequences Of Afmentioning

confidence: 99%

Psychological aspects of atrial fibrillation: A systematic narrative review

et al. 2020

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Purpose of the review Atrial fibrillation (AF) is the most frequent arrhythmia in the general population. This review aims to provide a comprehensive overview of the psychological aspects of AF, compiling evidence from epidemiological, clinical, and basic research sources. Recent findings Findings from large-scale population-based and clinical longitudinal studies reveal an association between negative affectivity (e.g. depression) and the incidence and clinical prognosis of AF. Studies investigating the impact of work stress parameters on AF onset show conflicting results. Researchers have reported the impact of AF on cognitive decline and on health-related quality of life, and have highlighted the role of interoceptive cues in the development of AF symptom burden and gender differences in psychological covariates of AF. Among biological pathways linking psychosocial factors to AF, research on autonomic regulation has yielded the most evidence so far, showing that the onset of AF is associated with simultaneous sympatho-vagal activation rather than an increase in vagal or sympathetic drive alone. Thus, modulation of the autonomic nervous system is likely to be a promising strategy for protecting the myocardium from pro-arrhythmic autonomic influences. Summary In total, the findings show that AF is embedded as a disease condition in a psycho-societal context and is not an isolated medical problem per se. A broader perspective than a focus on the electrophysiology alone is urgently needed.

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Anticoagulation in atrial fibrillation and cognitive decline

Abstract: Supplemental Digital Content is available in the text

Cited by 24 publications

References 39 publications

The problem of underdosing with direct-acting oral anticoagulants in elderly patients with nonvalvular atrial fibrillation

The problem of underdosing with direct-acting oral anticoagulants in elderly patients with nonvalvular atrial fibrillation

Determinants of cognitive performance and decline in 20 diverse ethno-regional groups: A COSMIC collaboration cohort study

Psychological aspects of atrial fibrillation: A systematic narrative review

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