The risk of patients with atrial fibrillation developing dementia is increased. Early oral anticoagulation may be beneficial, according to recent study results.
The lifetime risk of developing atrial fibrillation is 25%. Studies have shown that the disease is associated with an increased risk of premature cognitive decline as well as dementia. Another risk factor for dementia is stroke. Here, good results can be achieved with oral anticoagulants (OACs): the risk can be reduced by 60%, as Prof. Dr. med. Mischa Kühne, Basel, explained. The question suggested itself whether OAK may also have an impact on dementia risk. After all, if OAKs protect against large stroke-causing emboli, they could equally protect against small emboli. These cause microinfarcts,
that ultimately lead to cognitive damage.
For this purpose, 2415 patients were enrolled in a prospective, multicenter cohort study in Switzerland between April 2014 and August 2017. Comprehensive information about the clinical picture and its treatment is collected. Over a period of four years, cardiac function is checked annually using ECG and tests on cognitive functions are performed. The primary goal of the Swiss-AF cohort is the generation of a unique Swiss-wide database for future research and the recording of clinical consequences of atrial fibrillation in the long-term course.
The association between atrial fibrillation and dementia has already been shown in a Swedish retrospective registry study. Patients with OAK treatment at baseline were associated with a 29% lower risk of dementia than patients without OAK (HR 0.71, 95% Cl 0.68-0.74) and had a 48% lower risk on treatment (HR 0.52, 95% CI 0.50-055).
The results may indicate that early initiation of oral anticoagulant therapy may be beneficial in preserving cognitive function. “However, it is still unclear what the management will look like in concrete terms in the future,” Kühne concluded.
Source: Zurich Review Course in Clinical Cardiology.
CARDIOVASC 2019; 18(3): 38
