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Anticoagulation in the Aging Brain: Navigating the Intersection of Dementia, Cerebrovascular Risk, and Therapeutic

Antonella Mameli1, Francesco Marongiu1, Doris Barcellona1

  • 1University Hospital of Cagliari, Unit of Hemostasis and Thrombosis, Cagliari, Italy.

Current Vascular Pharmacology
|July 28, 2026
PubMed

Insights

Atrial fibrillation (AF) and dementia risk increase with age. Oral anticoagulation may reduce dementia risk in AF patients, but more research is needed to balance stroke prevention and bleeding in the elderly.

Area of Science:

  • Gerontology
  • Neurology
  • Cardiology

Background:

  • Global population aging correlates with increased dementia and atrial fibrillation (AF) incidence.
  • AF is linked to cognitive decline and subclinical brain injury beyond overt stroke.
  • These conditions frequently coexist, involving complex cerebrovascular and systemic mechanisms.

Purpose of the Study:

  • To review the relationship between AF, oral anticoagulation, and cognitive outcomes.
  • Focus on elderly patients and those with cognitive impairment.
  • Examine impact of anticoagulation on cognitive trajectories.

Main Methods:

  • Narrative review of literature from PubMed/MEDLINE, Scopus, and guideline databases.
  • Search included AF, anticoagulation, cognitive decline, dementia, and neurovascular injury.
  • Prioritized systematic reviews, meta-analyses, RCTs, cohort studies, and guidelines up to 2025.

Main Results:

  • Oral anticoagulation is key for stroke prevention in AF, but its cognitive impact is unclear.
  • Observational data suggest DOACs may lower dementia incidence, possibly by reducing microembolism.
  • Bleeding risk, especially intracerebral hemorrhage, impacts treatment decisions in frail populations.

Conclusions:

  • Anticoagulation management in AF patients with cognitive impairment requires balancing clot and bleeding risks.
  • A patient-centered, multidisciplinary approach is crucial for decision-making.
  • Further research is needed on long-term cognitive effects of anticoagulants in this group.
Abstract

Keywords:
Atrial fibrillationbraindementiaoral anticoagulation.stroke

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