A study has found that individuals with vascular dementia and atrial fibrillation (AF) have a greater risk of rehospitalization, stroke, and all-cause mortality than those with Alzheimer’s disease and AF, who face a higher risk of intracranial hemorrhage. It highlights the need for a more comprehensive approach to the management of AF patients, taking into account the risk of cognitive impairment and dementia. The results suggest that differentiating between dementia subtypes could be clinically relevant when it comes to selecting anticoagulation therapy and monitoring patients for potential adverse events.
Atrial fibrillation (AF) is a common arrhythmia that is associated with an increased risk of stroke, heart failure, and death. In addition, AF is also associated with an increased risk of cognitive impairment and dementia. Dementia is a broad term used to describe a range of symptoms that affect memory, thinking, and social abilities. Vascular dementia and Alzheimer’s disease are two of the most common types of dementia. Vascular dementia is caused by a reduction in the blood flow to the brain, as opposed to Alzheimer’s disease, which is characterized by the accumulation of beta-amyloid plaques and neurofibrillary tangles in the brain.
While the association between AF and dementia has been well documented, the clinical implications of this association have not been extensively studied. This study aimed to investigate the clinical outcomes of AF patients with vascular dementia and Alzheimer’s disease.
Methods:
This study analyzed data from 1,230 people with AF and a diagnosis of vascular dementia (n = 615) or Alzheimer’s disease (n = 615) using the TriNetX database, a global health research network with real-time updates of electronic medical records. The patients were stratified by dementia type and followed for 4 years for incident intracranial hemorrhages (ICH), the composite of ischemic stroke/transient ischemic attack (TIA), hospitalization, and all-cause mortality. Propensity score matching was used to balance the patients between the two groups.
Results:
During the follow-up period, 3.6% of patients with vascular dementia and 8.1% of patients with Alzheimer’s disease had incident ICH (HR = 2.22; 95% CI, 1.33–3.7; log‐rank P = .002). Patients with vascular dementia were more likely to experience rehospitalization (HR = 1.14; 95% CI, 1.01–1.31) and all-cause death (HR = 1.25; 95% CI, 1.01–1.58) compared with patients with Alzheimer’s disease. Overall, 38.5% of patients with vascular dementia and 31.4% of patients with Alzheimer’s disease developed an ischemic stroke or TIA. The risk for ischemic stroke/TIA was 1.32‐fold higher among people with vascular dementia (HR = 1.32; 95% CI, 1.09-1.59; log‐rank P = .003).
Discussion:
The results of this study suggest that AF patients with vascular dementia have a higher risk of stroke, rehospitalization, and mortality compared with those with Alzheimer’s disease. On the other hand, patients with Alzheimer’s disease have a higher risk of intracranial hemorrhage. The findings of this study highlight the need for a more holistic approach to the management of AF patients that takes into account the risk of cognitive impairment and dementia.
Current guidelines on AF recommend the use of oral anticoagulation therapy in patients with dementia according to their CHA2DS2‐VASc score and good control of risk factors. However, the guidelines do not differentiate between dementia subtypes. The results of this study suggest that such differentiation may be clinically relevant, as it may affect the choice of anticoagulation therapy and the monitoring of patients for potential adverse events.
