Incident Atrial Fibrillation, Dementia and the Role of Anticoagulation: A Population-Based Cohort Study

Thalia S. Field; Bob Weijs; Antonio Curcio; Michela Giustozzi; Saulius Sudikas; Anja Katholing; Christopher Wallenhorst; Jeffrey I. Weitz; Alexander T. Cohen; Carlos Martinez

doi:10.1055/s-0039-1683429

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2019; 119(06): 981-991
DOI: 10.1055/s-0039-1683429

Stroke, Systemic or Venous Thromboembolism

Georg Thieme Verlag KG Stuttgart · New York

Incident Atrial Fibrillation, Dementia and the Role of Anticoagulation: A Population-Based Cohort Study

Thalia S. Field ^*

¹Division of Neurology, Vancouver Stroke Program, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada

,

Bob Weijs^*

²Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands

,

Antonio Curcio

³Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy

,

Michela Giustozzi

⁴Department of Internal Medicine, Università degli Studi di Perugia, Perugia, Italy

,

Saulius Sudikas

⁵Department of Surgery, Kantonsspital Winterthur, Zurich, Switzerland

,

Anja Katholing

⁶Institute for Epidemiology, Statistics and Informatics GmbH, Frankfurt, Germany

,

Christopher Wallenhorst

⁶Institute for Epidemiology, Statistics and Informatics GmbH, Frankfurt, Germany

,

Jeffrey I. Weitz

⁷Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada

,

Alexander T. Cohen

⁸Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom

,

Carlos Martinez

⁶Institute for Epidemiology, Statistics and Informatics GmbH, Frankfurt, Germany

› Author Affiliations

Abstract

Introduction Atrial fibrillation (AF) is associated with dementia. Anticoagulation may modify this relationship, but it is unclear if this is due to stroke reduction alone.

Methods Age- and sex-matched individuals from the U.K. Clinical Practice Research Datalink (2008–2016) with and without an incident diagnosis of AF were followed for a new dementia diagnosis. We estimated adjusted hazard ratios (aHRs) for incident dementia diagnosis in the AF cohort, overall and stratified by anticoagulation status, using the matched non-AF cohorts as reference. We performed a sensitivity analysis excluding individuals with stroke/transient ischaemic attack (TIA) before the observation period.

Results Over 193,082 person-years (mean follow-up 25.7 ± 0.1 months), 347/15,276 AF (2.3%) and 1,085/76,096 non-AF (1.4%) were newly diagnosed with dementia (aHR, 1.31, 95% confidence interval, 1.15–1.49). The AF group had more co-morbidity and higher rates of dementia, both with and without anticoagulation, than non-AF. When those with history of stroke/ TIA before the observation period were excluded and those with incident stroke/TIA during the observation period were censored, AF individuals not on anticoagulation had significantly higher rates of dementia compared with non-AF, aHR 1.30 (1.06–1.58).

Conclusion Our findings support the hypothesis that AF is a distinct risk factor for dementia, independent of stroke/TIA and other vascular risk factors. In those without stroke/TIA, risk of dementia is increased only in those who are not on anticoagulation, suggesting anticoagulation is protective presumably through reduction of sub-clinical embolic events. Further prospective research is needed to better ascertain the role of anticoagulation amongst targeted therapeutic strategies to reduce cognitive decline in AF.

Keywords

dementia - atrial fibrillation - stroke - TIA - anticoagulation - risk factors - population study

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References

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Supplementary Material