March 25, 2026Open Access

Impact of anticoagulation on cognitive decline and clinical outcomes in patients with atrial fibrillation and dementia: A retrospective cohort study

Key Result

Anticoagulation in patients with atrial fibrillation and dementia slowed cognitive decline and reduced hospitalization (HR 0.60) and all-cause mortality (HR 0.59).

Key Points

To evaluate the impact of anticoagulation on cognitive and clinical outcomes in patients with atrial fibrillation and dementia.
Retrospective cohort study design involving 291 patients aged ≥65 years with AF and dementia.
Patients grouped by anticoagulation status for analysis.
Cognitive and functional outcomes assessed using MMSE, ADL, and CDR-SB over a median follow-up of 28 months.
Clinical endpoints included all-cause mortality and hospitalization.
Statistical analyses employed multivariable Cox models.
Anticoagulated patients were younger by an average of 2.3 years (82.8 versus 85.1).
Anticoagulation linked to slower cognitive decline with medium effect sizes: ΔMMSE 2.0 points, ΔADL 10.9 points, ΔCDR-SB -1.4 points.
Cox models showed reduced hospitalization risk (HR 0.60) and lower all-cause mortality (HR 0.59) in anticoagulated patients.
Benefits most significant in those with very mild dementia and Alzheimer's disease.

Structured PICO

Does anticoagulation reduce cognitive decline, hospitalization, and mortality in older adults with atrial fibrillation and dementia?

Population

291 patients aged ≥65 years with atrial fibrillation and dementia, treated at a tertiary center

Intervention

Anticoagulation therapy

Comparator

No anticoagulation (grouped by anticoagulation status)

Outcome

Cognitive and functional outcomes (Mini-Mental State Examination [MMSE], Activities of Daily Living [ADL], Clinical Dementia Rating–Sum of Boxes [CDR-SB]) and clinical endpoints (all-cause mortality, hospitalization, major adverse cardiovascular events, and bleeding) over a median 28-month follow-up

In older adults with atrial fibrillation and dementia, anticoagulation is associated with slower cognitive and functional decline, as well as significantly lower risks of hospitalization and all-cause mortality.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Background Atrial fibrillation (AF) and dementia frequently coexist in older adults, yet the impact of anticoagulation on cognitive and clinical outcomes in this population remains uncertain. Objective To evaluate the effects of anticoagulation on cognitive and clinical outcomes in patients with AF and dementia. Methods This retrospective cohort study included 291 patients aged ≥65 years with AF and dementia, treated at a tertiary center between January 2020 and December 2024. Patients were grouped by anticoagulation status. Cognitive, functional outcomes (Mini-Mental State Examination MMSE, Activities of Daily Living ADL, Clinical Dementia Rating–Sum of Boxes CDR-SB) and clinical endpoints (all-cause mortality, hospitalization, major adverse cardiovascular events, and bleeding) were assessed over a median 28-month follow-up. Results Anticoagulated patients were younger (82.8 versus 85.1 years, p = 0.01). Anticoagulation was associated with slower cognitive/functional decline, with medium effect sizes, ΔMMSE mean difference: 2.0 points (95% CI: −3.5 to −0.4; p = 0.048), ΔADL mean difference: 10.9 points (95% CI: −19.6 to −2.3; p = 0.02), ΔCDR-SB mean difference: −1.4 points (95% CI: 0.4 to 2.4; p < 0.01). In multivariable Cox models, anticoagulation reduced hospitalization risk (HR 0.60; 95% CI: 0.43–0.84; p < 0.01) and all-cause mortality (HR 0.59; 95% CI: 0.40–0.88; p = 0.01). Benefits were most pronounced in very mild dementia and Alzheimer's disease. Conclusions In this retrospective, confounder-adjusted study, anticoagulation was associated with slower cognitive/functional decline and lower hospitalization/mortality risk in AF and dementia patients. The findings warrant prospective research to investigate whether anticoagulation has disease-modifying effects in early-stage dementia.