Why the study?
Controversy exists regarding the effects of warfarin and direct oral anticoagulants on the risk of cognitive decline and dementia in AF, and mechanisms linking AF to dementia independently of stroke are not fully understood.
Does oral anticoagulation prevent cognitive decline and dementia in patients with atrial fibrillation?
Does oral anticoagulation prevent cognitive decline and dementia in patients with atrial fibrillation?
Atrial fibrillation is independently associated with dementia, but the protective effects of warfarin and direct oral anticoagulants against cognitive decline remain controversial.
AF-dementia link and uncertain OAC effects on cognition leave open whether anticoagulation prevents decline; RCTs needed.
Atrial fibrillation (AF) is one of the cardiovascular risk factors for dementia. Several longitudinal studies have reported an association between AF and dementia independently of stroke history. Although the mechanisms underlying this association are not fully understood, proposed mechanisms include cerebral hypoperfusion, inflammation, genetic factors, cerebral microbleeds, and recurrent silent cerebral ischemia. Oral anticoagulation can be used to minimize risk of cognitive decline and dementia, given that brain insults can be caused by chronic microemboli or microbleeds. However, controversy on the effects of warfarin and direct oral anticoagulants on this risk exists. This article will address these aspects, with data on the studies already published and a critical view on this subject.
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Silva et al. (2019) studied this question.
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