Related Experiment Video
Updated: Dec 23, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Association Between Atrial Fibrillation and Cognitive Impairment in Individuals With Prior Stroke: A Meta-Analysis
Damianos G Kokkinidis1, Nikos Zareifopoulos2,3, Christina A Theochari4
1From the Department of Medicine, Jacobi Medical Center (D.G.K., A.A.-M., D.U.), Albert Einstein College of Medicine, New York, NY.
Insights
Atrial fibrillation (AF) may increase the risk of cognitive impairment (CI) and dementia in stroke survivors. This systematic review found a significant association, though heterogeneity limits certainty.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Atrial fibrillation (AF) is a common arrhythmia.
- Dementia and cognitive impairment (CI) pose significant public health challenges.
- Population aging is increasing the prevalence of AF, CI, and dementia.
Purpose of the Study:
- To investigate the impact of atrial fibrillation (AF) on the risk of dementia or cognitive impairment (CI).
- Specifically evaluate this risk in patients with a history of stroke.
Main Methods:
- Systematic review and meta-analysis following PRISMA guidelines.
- Searched databases: Pubmed, Scopus, and Cochrane Central.
- Analyzed adjusted odds ratios from 14 studies including 14,360 patients.
Main Results:
- Atrial fibrillation (AF) was associated with increased risk of CI (OR, 1.60).
- AF showed increased risk for dementia (OR, 3.11) and composite CI/dementia (OR, 2.26).
- Moderate to substantial heterogeneity was observed across analyses.
Conclusions:
- An association between atrial fibrillation (AF) and cognitive impairment (CI) or dementia is possible in patients with prior strokes.
- Findings persisted in unadjusted and adjusted analyses.
- Heterogeneity levels necessitate caution in interpreting the certainty of these findings.
Abstract:
Background and Purpose- Atrial fibrillation (AF) is the most common chronic arrhythmia. Dementia and cognitive impairment (CI) are major burdens to public health. The prevalence of all 3 entities is projected to increase due to population aging. Previous reports have linked AF with a higher risk of CI and dementia in patients without prior stroke. Stroke is known to increase the risk for dementia and CI. It is unclear if AF in patients with history of stroke can further increase the risk for dementia or CI. Our purpose was to evaluate the impact of AF on risk for dementia or CI among patients with history of stroke. Methods- Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were followed. Pubmed, Scopus, and Cochrane central were searched. The outcomes of interest were dementia, CI, and the composite end point of dementia or CI. A random-effect model meta-analysis was performed. Meta-regression analysis was also performed. Publication bias was assessed with the Egger test and with funnel plots. Results- Fourteen studies and 14 360 patients (1363 with AF) were included in the meta-analysis. In the meta-analysis of adjusted odds ratio, AF was associated with increased risk of CI (odds ratio, 1.60 [95% CI, 1.20-2.14]), dementia (odds ratio, 3.11 [95% CI, 2.05-4.73]), and the composite end point of CI or dementia (odds ratio, 2.26 [95% CI, 1.61-3.19]). The heterogeneity for the composite end point of dementia or CI was moderate (adjusted analysis). The heterogeneity for the analysis of the end point of CI only was substantial in the unadjusted analysis and moderate in the adjusted analysis. The heterogeneity for the end point of dementia only was moderate in the unadjusted analysis and zero in the adjusted analysis. Conclusions- Our results indicate that an association between AF and CI or dementia is patients with prior strokes is possible given the persistent positive associations we noticed in the unadjusted and adjusted analyses. The heterogeneity levels limit the certainty of our findings.
