AF diagnosis linked to mild cognitive decline

Atrial fibrillation (AF) diagnosis was linked to a 45% increased risk of mild cognitive impairment (MCI), according to international research published in JACC: Advances.

The researchers used the primary electronic health record (EHR) data from 4.3 million people to look at the rate of mild cognitive impairment after atrial fibrillation diagnosis, and found 233,833 individuals with incident AF and 233,747 without AF.

MCI is an early stage of cognitive function decline — in some cases it can be reversed, but it can indicate development of early dementia-associated disease. There has not been sufficient research on the development of MCI in AF patients and the subsequent development of dementia, which prompted the authors to investigate the association.

In addition to the 45% increased risk of MCI after AF diagnosis, the study found that a higher MCI risk was associated with older age, female sex, higher socioeconomic deprivation, clinical history of depression, stroke and multimorbidity. These factors, however, did not modify the link between AF and MCI. For individuals over 74 years old, AF and MCI were frequently diagnosed when multimorbidity was detected, including diabetes, depression, hypercholesterolemia and peripheral artery disease.

During the study period, 1117 individuals were diagnosed with dementia on or after a diagnosis of MCI. AF was linked with a higher risk of dementia among those who had developed MCI.

Patients with AF who were treated with digoxin did not experience an increased MCI risk. The risk of MCI was higher in patients with AF who did not receive oral anticoagulant treatment and amiodarone treatment. Similarly, patients with AF who received oral anticoagulant treatment and amiodarone treatment were not at risk of MCI.

“Progression from MCI to dementia appears to be, at least partially, mediated by cardiovascular risk factors and the presence of multiple comorbidities,” said Rui Providencia, a professor at the Institute of Health informatics Research at University College London and the study’s senior author.

The researchers said these findings suggest that integrated AF care, such as combining anticoagulation and comorbidity management, could help prevent cognitive deterioration and the progression to dementia. A confirmatory clinical trial is needed to explore this topic further.

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