A new study published in the European Heart Journal has found that patients who suffer from atrial fibrillation have an increased risk of dementia, even in people who have not suffered a stroke. This is the largest study to investigate the association in an elderly population.
Atrial fibrillation is an irregular and often abnormally fast heartbeat. It is the most common heart rhythm problem among elderly people aged 80 and older, affecting between 2.7 and 6.1 million adults in the United States. It has been shown to increase the risk of medical problems, including stroke and even death.
The study looked at 262,611 people over the age of 60 years who were involved in the Korea National Health Insurance Service Senior cohort. All participants were free of AF and dementia when the study started in 2004. Researchers then followed participants until the end of 2013.
During the study, AF was diagnosed in 10,435 of participants. In those who developed AF, 24.4 percent developed dementia during the follow-up period compared to 14.4 percent who developed dementia among those who were not diagnosed with atrial fibrillation. This clearly showed a link between the incidence of AF and dementia. In addition, the study found that AF patients who took oral anticoagulants to prevent blood clots had a decreased risk of dementia.
An Increased Risk
The study was led by Boyoung Joung, a professor of cardiology and internal medicine at Yonsei University College of Medicine, Seoul, South Korea. He spoke about the findings of the research, saying, “We found that the people who developed atrial fibrillation had a 50 percent increased risk of developing dementia compared to those who did not develop the condition; this increased risk remained even after we removed those who suffered a stroke from our calculations. This means that, among the general population, an extra 1.4 people per 100 of the population would develop dementia if they were diagnosed with atrial fibrillation. The risk occurred in people aged younger and older than 70 years.”
“We also found that atrial fibrillation increased the risk of Alzheimer’s disease by 30 percent and more than doubled the risk of vascular dementia. However, among people who developed atrial fibrillation and who took oral anticoagulants, such as warfarin, or non-vitamin K anticoagulants, such as dabigatran, rivaroxaban, apixaban or edoxaban, the risk of subsequently developing dementia reduced by 40 percent compared to patients who did not take anticoagulants.”
Prof. Joung spoke about the conclusion of the study, “Dementia is an untreatable disease and so prevention is important. This study confirms that atrial fibrillation is a risk factor for the development of dementia. Therefore, the prevention of atrial fibrillation may be a means to reduce the incidence of dementia. In patients with atrial fibrillation, our results suggest we can reduce the incidence of dementia through the use of anticoagulants. It is expected that non-vitamin K anticoagulants, which have a significantly lower risk of cerebral haemorrhage than warfarin, may be more effective than warfarin in terms of dementia prevention and this will be answered by an ongoing clinical trial. Furthermore, investigations should be carried out into whether aggressive rhythm control, such as catheter ablation, helps to prevent dementia.”
As populations age, experts have predicted AF will escalate throughout the older population. The incidence of AF has started to increase, although inconsistent, evidence has begun to show that it may contribute to the development of thinking problems and dementia.
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