Atrial fibrillation – an analysis from the perspective of cognitive decline

Introduction: Atrial fibrillation (AF) patients are at high risk of developing cognitive (CD) dysfunction and dementia, independently of stroke. The investigation of the two main possible reasons (cardio-embolic and ce-rebral hypoperfusion theory) may have an effect on the reduction of CD burden.

Objective: We aimed to assess the prevalence of cogni-tive dysfunction in patients with atrial fibrillation and to investigate the relationship between the deteriorati-on of cognitive functions, CHA2DS2-VASc score and AF management.

Methods: We included 506 consecutive patients ad-mitted to our clinic (mean age: 68 ± 10 years; 52.2% females, 47.8% males). The prevalence of AF was 26.5% (n=134 patients; paroxysmal AF: 37.2%, persistent AF: 20.9%, permanent AF: 41.9%). Mean age in AF patients vs. patients in sinus rhythm (SR) was 66 vs. 73 years. Besides routine clinical evaluation, cognitive status was assessed with the Mini Mental State Examinati-on (MMSE) and the Montreal Cognitive Assessment (MoCA) questionnaires. CHA2DS2-VASc score was calculated for all patients and data referring to AF pat-tern, rate or rhythm control therapy, and type of anti-coagulation were collected.

Results: MMSE and MoCA scores were significantly lower in patients with AF than in patients in sinus rhythm (SR), mean MMSE: 25.42 vs. 26.52 (p=0.003) and mean MoCA: 23.11 vs. 21.75 (p=0.005). Mean CHA2DS2-VASc score was 3.8 vs. 4.3 points. Ove-rall CHA2DS2-VASc score negatively correlated with MoCA scores (r=-0.337, p=0.01). Patients with CHA2DS2-VASc ≥2 points (independently from gen-der) had significantly lower cognitive scores (MMSE p=0.08; MoCA p=0.42). Patients in SR with CHA-2DS2-VASc ≥3 had significantly lower cognitive scores compared to patients with CHA2DS2-VASc <3 points (MMSE p=0.00; MoCA p=0.019). This difference was not observed in patients with AF (MMSE p=0.40; MoCA p=0.85). AF patients with direct oral antico-agulants (41.1%) had significantly higher MoCA and MMSE scores. No significant differences were found between the patterns of AF and CD, neither between rate (60.5%) nor rhythm (39.5%) control therapy.

Conclusions: AF patients have lower cognitive per-formances. Higher CHA2DS2-VASc score suggests a higher risk of cognitive deterioration, which could be prevented with oral anticoagulation treatment, especi-ally with non-vitamin K antagonists.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
ESC search engine
CODE: 379
CME Credits: 10 (Romanian College of Physicians)