Key result
Atrial fibrillation is associated with an 81% increased risk of dementia (HR 1.81; 95% CI 1.43-2.30) and a 25% increased risk of cognitive impairment (HR 1.25; 95% CI 1.04-1.49).
Why the study?
Does atrial fibrillation increase the risk of cognitive impairment and dementia?
Meta-Analysis
Does atrial fibrillation increase the risk of cognitive impairment and dementia?
Atrial fibrillation is significantly associated with an increased risk of both cognitive impairment and dementia, with neuropathology showing clinical and silent cerebral infarcts and decreased brain volumes.
AF may raise dementia risk; observational meta-analysis leaves open whether interventions modify outcomes.
Background: Atrial fibrillation (AF) has been associated with minor cognitive impairment and dementia. Objective: 1. Meta-analysis to examine the association of AF with dementia. 2. Systematic review of mechanistic link between AF and dementia. Methods: PubMed/ EMBASE/COCHRANE were searched with key words “atrial fibrillation”, “cognitive impairment” and “dementia” and identified 5083 articles. After exclusions, 25 prospective cohort studies reporting relationship between AF and cognitive impairment or dementia were selected. 17 studies were selected to systematically review neuropathology in AF patients with dementia. Data was analyzed by a random-effects meta-analysis. A pre-specified sub-analysis was performed for post-stroke dementia. Results: AF is associated with 25% increased risk of cognitive impairment (8 studies, HR: 1.25 [1.04–1.49], I2=57%) and 81% increased risk of dementia (17 studies, HR: 1.81 [1.43–2.30], I2 =98%). On sub-analysis by stroke status, AF was significantly associated with both cognitive impairment (4 studies, HR: 1.13 [1.03–1.24], I2= 0%) and dementia (12 studies, HR: 1.55 [1.27–1.89], I2= 69%) in post-stroke patients. In absence of stroke, AF was only associated with cognitive impairment (4 studies, HR: 1.87 [1.07–3.28], I2= 80%). Neuropathology studies demonstrate clinical and silent cerebral infarcts and decreased brain volumes in AF patients with cognitive impairment or dementia.
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Mahajan et al. (2017) conducted a meta-analysis in Atrial fibrillation. Atrial fibrillation vs. Absence of atrial fibrillation was evaluated on Dementia (HR 1.81, 95% CI 1.43-2.30). Atrial fibrillation is associated with an 81% increased risk of dementia (HR 1.81; 95% CI 1.43-2.30) and a 25% increased risk of cognitive impairment (HR 1.25; 95% CI 1.04-1.49).
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