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Dementia and Atrial Fibrillation: A Dangerous Combination for Ischemic Stroke and Mortality

Daniele Pastori1,2, Kazuo Miyazawa1, Gregory Y H Lip1,3

  • 1Institute for Cardiovascular Sciences, University of Birmingham, Birmingham, UK.

Journal of Alzheimer'S Disease : JAD
|January 15, 2018
PubMed

Insights

Patients with atrial fibrillation (AF) and dementia need adequate anticoagulation for stroke prevention. Cognitive assessment aids in choosing the right anticoagulant and managing treatment effectively.

Area of Science:

  • Cardiology
  • Neurology
  • Geriatrics

Background:

  • Atrial fibrillation (AF) increases dementia risk, with both conditions rising with age.
  • Dementia patients often receive inadequate anticoagulation due to monitoring and compliance challenges.
  • Under-treatment in AF patients with dementia elevates risks of stroke and mortality.

Purpose of the Study:

  • To evaluate the role of cognitive impairment in managing oral anticoagulation for AF patients.
  • To determine optimal anticoagulant selection and treatment strategies for AF patients with cognitive impairment.
  • To highlight the importance of integrated care pathways for AF patients with dementia.

Main Methods:

  • Literature review and clinical guideline analysis.
  • Analysis of treatment outcomes in AF patients with varying cognitive statuses.
  • Evaluation of risk stratification scores (e.g., SAMe-TT2R2) in the context of cognitive impairment.

Main Results:

  • Cognitive impairment is a critical factor in AF patient anticoagulation management.
  • Under-treatment is prevalent, contributing to adverse events in AF patients with dementia.
  • Integrating cognitive assessment into decision-making improves anticoagulant choice and adherence.

Conclusions:

  • AF patients with dementia require and benefit from appropriate anticoagulation for stroke prevention.
  • Cognitive function assessment is crucial for selecting appropriate oral anticoagulants (VKAs vs. NOACs).
  • Enhanced social support and cognitive monitoring are key to managing these complex patients.

Keywords:
Anticoagulationatrial fibrillationdementiaischemic strokemortality

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