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Predictors of Cognitive
Impairment and Dementia in
Persons with Atrial
Fibrillation
Some studies have found that higher CHADS2
and CHA2DS2-VASc scores, stratification
schemes commonly used to inform
anticoagulant treatment in persons with AF,
predict dementia in these patients
This association is not surprising, given that
age, possibly the strongest predictor of
dementia, is part of the scores. Dementiaspecific risk models are likely to provide
more accurate predictions
Predictors of Cognitive
Impairment and Dementia in
Persons with Atrial
data
from the Intermountain Healthcare Clinical
Fibrillation
Pharmacist Anticoagulation Service, in Utah, US, reported
that low percent of time in the therapeutic range among
users of vitamin K antagonists were at higher risk of
dementia due to under- or overcoagulation
Though informative, these studies are limited in that they
cannot determine whether baseline cognitive function
confounds the association between suboptimal oral
anticoagulation and the future risk of dementia. For
example, individuals with worse cognitive function at the
time of initiation of oralanticoagulation may have more
problems following an adequate therapeutic regime and
would be at higher risk of being diagnosed with dementia
later on
Prevention of Cognitive
Impairment in Persons with
Atrial
CurrentFibrillation
guidelines recommend oral
Prevention of Cognitive
Impairment in Persons with
Atrial
Fibrillation
A recent
clinical trial including 973 elderly
Prevention of Cognitive
Impairment in Persons with
Atrial
Fibrillation
A randomized
trial of weight loss and risk factor
management in 150 AF patients led to clinically
significant reductions in AF burden and
symptoms, and improved cardiac function
Similar findings were obtained in 355 AF
patients participating in a weight loss
intervention, where those who experience
sustained weight loss had reductions in AF
burden and were more likely to remain in sinus
rhythm
Prevention of Cognitive
Impairment in Persons with
Atrial
RecentFibrillation
studies indicate that dietary
Conclusion
A growing and consistent body of literature
supports a role for AF as a risk factor for
cognitive decline and dementia
The mechanisms responsible for this association
are diverse and go beyond the well-established
increased stroke risk in persons with AF
Future research needs to deepen the
understanding of those mechanisms and, more
importantly, develop interventions that reduce
the burden of adverse cognitive outcomes
associated with AF.