Risk of dementia in stroke-free patients diagnosed with atrial fibrillation: data from a population-based cohort

Abstract

Aims Atrial fibrillation (AF) is generally regarded as a risk factor for dementia, though longitudinal studies assessing the association between AF and dementia have shown inconsistent results. This study aimed to determine the effect of AF on the risk of developing dementia using a longitudinal, community-based, and stroke-free elderly cohort. Methods and results The association of incident AF with the development of incident dementia was assessed from 2005 to 2012 in 262 611 dementia- and stroke-free participants aged ≥60 years in the Korea National Health Insurance Service-Senior cohort. Incident AF was observed in 10 435 participants over an observational period of 1 629 903 person-years (0.64%/year). During the observational period, the incidence of dementia was 4.1 and 2.7 per 100 person-years in the incident AF and propensity score-matched AF-free groups, respectively. After adjustment, the risk of dementia was significantly increased by incident AF with a hazard ratio (HR) of 1.52 [95% confidence interval (CI) 1.43–1.63], even after censoring for stroke (1.27, 95% CI 1.18–1.37). Incident AF increased the risk of both Alzheimer (HR 1.31, 95% CI 1.20–1.43) and vascular dementia (HR 2.11, 95% CI 1.85–2.41). Among patients with incident AF, oral anticoagulant use was associated with a preventive effect on dementia development (HR 0.61, 95% CI 0.54–0.68), and an increasing CHA2DS2-VASc score was associated with a higher risk of dementia. Conclusion Incident AF was associated with an increased risk of dementia, independent of clinical stroke in an elderly population. Oral anticoagulant use was linked with a decreased incidence of dementia.

The Effect of Integrated Care Management on Dementia in Atrial Fibrillation

“…AF also increases the occurrence of comorbid chronic diseases [ 3 ]. Little is known about the pathophysiological mechanisms of dementia, but there is increasing evidence that AF is related to cognitive dysfunction and dementia [ 4 , 5 , 6 , 7 ].…”

What Is the Ideal Blood Pressure Threshold for the Prevention of Atrial Fibrillation in Elderly General Population?

“…First, in such studies using administrative databases, coding inaccuracies can lead to errors. Hence, we applied the definition that we had already validated in previous studies to minimize the problem [21,[24][25][26][27][28]. Second, since the health examination of individuals was conducted in different hospitals and clinics, a uniformity of BP measurement could not be achieved.…”

Anticoagulation in Atrial Fibrillation Patients

“…In an elderly population (262,611 patients ≥60 years free of dementia and stroke), it was observed that incident AF was associated with an increased risk of dementia independent of stroke, while anticoagulation therapy decreased the risk for dementia [70]. The association between AF and dementia is not well elucidated, but white matter lesions, silent brain infarcts, and microbleeds in the brain are more common in AF patients, and it is not clear whether anticoagulation might play a role in this decreased risk for dementia [71].…”