Association Between Atrial Fibrillation and Dementia: A Meta-Analysis

Islam, Mohaimenul; Poly, Tahmina Nasrin; Walther, Bruno; Yang, Hsuan-Chia; Wu, Chieh-Chen; Lin, Ming‐Chin; Chien, Shuo-Chen; Li, Yu-Chuan

doi:10.3389/fnagi.2019.00305

Cited by 45 publications

(34 citation statements)

References 66 publications

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“…In a most recent meta-analysis of 16 studies including 2,415,356 individuals, subgroup analyses reveal that the association between AF and dementia risk appears to be stronger in studies with a follow-up duration > 5 years [29]. In the Rotterdam study, although the risk of all-cause dementia was highest for people who experienced the longest duration of AF, this dose-response relationship was only present in younger participants [30].…”

Section: Psychosocial Consequences Of Af Cognitionmentioning

confidence: 99%

“…However, clinically diagnosed stroke represents only the tip of the iceberg, as AFinduced brain ischemia and silent brain infarcts [22] are associated with cognitive impairment and dementia [23] as well. Increasing evidence from meta-analyses that include large prospective epidemiological studies demonstrate that AF may be a predictor of cognitive impairment and increased risk of dementia (hazard ratios [HR] ranging from 1.3 to 2.3), with or without a history of stroke [24][25][26][27][28][29].…”

Section: Psychosocial Consequences Of Af Cognitionmentioning

confidence: 99%

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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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Section: Psychosocial Consequences Of Af Cognitionmentioning

confidence: 99%

Section: Psychosocial Consequences Of Af Cognitionmentioning

confidence: 99%

Psychological aspects of atrial fibrillation: A systematic narrative review

et al. 2020

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“…Compared to the latest meta‐analysis available on this topic, 52 our study added data from 1.144.175 subjects, which represent a significant population, helpful in further elucidating the relationship between AF and dementia. Moreover, this and an earlier meta‐analyze on the same topic comprehensively included patients with dementia and MCI, 52 , 53 whereas our investigation specifically focused on dementia.…”

Section: Discussionmentioning

confidence: 99%

Risk of dementia in patients with atrial fibrillation: Short versus long follow‐up. A systematic review and meta‐analysis

Zuin

Roncon

Passaro

et al. 2021

Int J Geriat Psychiatry

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Background No previous meta‐analyses have compared the risk of dementia, due to an underlying atrial fibrillation (AF), in the short‐term versus the long‐term period. Aim To perform an update meta‐analysis of studies examining the association between AF and dementia and the relative impact of follow‐up period. Methods Data were obtained searching MEDLINE and Scopus for all investigations published between 1 January 2000 and March 1, 2021 reporting the risk of dementia in AF patients. The following MeSH terms were used for the search: “Atrial Fibrillation” AND “Dementia” OR “Alzheimer’s disease”. From each study, the adjusted hazard ratio (aHR) with the related 95% confidence interval (CI) was pooled using a random effect model. Results The analysis was carried out on 18 studies involving 3.559.349 subjects, of which 902.741 (25.3%) developed dementia during follow‐up. A random effect model revealed an aHR of 1.40 (95% CI: 1.27–1.54, p < 0.0001; I2 = 93.5%) for dementia in subjects with AF. Stratifying the studies according to follow‐up duration, those having a follow‐up ≥10 years showed an aHR for dementia of 1.37 (95% CI: 1.21–1.55, p < 0.0001, I2 = 96.6%), while those with a follow‐up duration <10 years has a slightly higher aHR for dementia (HR: 1.59, 95%CI: 1.51–1.67, p < 0.0001, I2 = 49%). Nine studies showed that the aHR for Alzheimer’s disease (AD) in AF patients was 1.30 (95%CI: 1.12–1.51, p < 0.0001, I2 = 87.6%). Conclusions Evidence suggests that patients with AF have an increased risk of developing dementia and AD. The risk of dementia was slightly higher when the follow‐up was shorter than 10 years.

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“…Many prospective and retrospective studies have stressed a strong association between AF and dementia in patients without stroke (risk ratio (RR) [95% confidence interval (CI)] = 1.34 [1.13, 1.58]), in patients with first-ever or recurrent stroke (RR [95% CI] = 2.7 [1.82, 4.00]) and in a general population including with or without a history of stroke (RR [95% CI] = 1.36 [1.23, 1.51]). 3,4 Proposed mechanisms underlying this link involved overt or covert strokes, cerebral hypoperfusion because of reduced cardiac output present in AF rhythm, inflammation and presence of shared risk factors for AF and dementia. 5,6 Among them, the clinical or subclinical embolic brain ischaemia is considered to be the main cause of cognitive decline associated with AF.…”

Section: Introductionmentioning

confidence: 99%

A systematic review and meta‐analysis to determine the effect of oral anticoagulants on incidence of dementia in patients with atrial fibrillation

et al. 2021

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Aims:To assess the effect of oral anticoagulant (OAC) administration on incidence of dementia in patients with atrial fibrillation (AF) with Systematic review and meta-analysis. Methods:We systematically searched the electronic databases including Pubmed, Embase, Cochrane library and ClinicalTrails.gov for relevant articles. The primary outcome was the incidence of dementia. The adjusted risk ratio (RR), odds ratio or hazard ratio were extracted and pooled by the random-effects models. Subgroup analysis was performed according to the setting observational window. Risk of bias was assessed using the Newcastle-Ottawa Scale, while publication bias was assessed by the Begg's and Egger's tests.Results: Nine studies were included in this review (2 prospective and 7 retrospective observational studies, including 613,920 patients). The results presented the significant association between OAC therapy and the reduced risk of dementia compared with no treatment (RR [95% CI] = 0.72 [0.60, 0.86], I 2 = 97.2%; P = .000). In the subgroup analysis with an observational window, the pooled RR became statistically non-significant (including four studies, RR [95% CI] = 0.75 [0.51, 1.10], I 2 = 98.8%; P = .000). There is no significant risk of bias and publication bias. Conclusions:This study indicated the protective effect of OAC therapy for dementia in patients with AF. However, the results are limited because of high heterogeneity, inconsistent direction of effect in subgroup analysis with an observational window.Further prospective well-designed study is needed with longer follow-up duration in younger patients. Review criteria• The inclusion criteria were as follows: (a) patients with AF who were ≥18 years; (b) investigating the effects of OACs on the incidence of dementia; (c) reporting the outcomes as HR, RR or OR, with 95% CIs; (d) RCTs or observational studies. • The exclusion criteria were as follows: (a) patients with the history of dementia or moderateto-severe cognitive dysfunction; (b) only crude or unadjusted HR, RR or OR; (c) crosssectional studies; (d) following types of articles: conference abstracts, editorials, letters, expert opinions, case reports, case series or reviews.

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Association Between Atrial Fibrillation and Dementia: A Meta-Analysis

Cited by 45 publications

References 66 publications

Psychological aspects of atrial fibrillation: A systematic narrative review

Psychological aspects of atrial fibrillation: A systematic narrative review

Risk of dementia in patients with atrial fibrillation: Short versus long follow‐up. A systematic review and meta‐analysis

A systematic review and meta‐analysis to determine the effect of oral anticoagulants on incidence of dementia in patients with atrial fibrillation

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