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Meta-Analysis
. 2021 Oct;36(10):3122-3135.
doi: 10.1007/s11606-021-06954-8. Epub 2021 Jul 9.

Atrial Fibrillation Is Associated with Cognitive Impairment, All-Cause Dementia, Vascular Dementia, and Alzheimer's Disease: a Systematic Review and Meta-Analysis

Christos A Papanastasiou  1 , Christina A Theochari  2 , Nikos Zareifopoulos  3 , Angelos Arfaras-Melainis  4 , George Giannakoulas  1 , Theodoros D Karamitsos  1 , Leonidas Palaiodimos  4 , George Ntaios  5 , Konstantinos I Avgerinos  6 , Dimitrios Kapogiannis  6 , Damianos G Kokkinidis  7
Affiliations
Meta-Analysis

Atrial Fibrillation Is Associated with Cognitive Impairment, All-Cause Dementia, Vascular Dementia, and Alzheimer's Disease: a Systematic Review and Meta-Analysis

Christos A Papanastasiou et al. J Gen Intern Med. 2021 Oct.

Abstract

Background: Atrial fibrillation (AF) is a risk factor for cognitive impairment and dementia in patients with stroke history. However, the association between AF and cognitive impairment in broader populations is less clear.

Objective: To systematically review and quantitatively synthesize the existing evidence regarding the association of AF with cognitive impairment of any severity and etiology and dementia.

Methods: Medline, Scopus, and Cochrane Central were searched in order to identify studies investigating the association between AF and cognitive impairment (or dementia) cross-sectionally and longitudinally. Studies encompassing and analyzing exclusively patients with stroke history were excluded. A random-effects model meta-analysis was conducted. Potential sources of between-study heterogeneity were investigated via subgroup and meta-regression analyses. Sensitivity analyses including only studies reporting data on stroke-free patients, vascular dementia, and Alzheimer's disease were performed.

Results: In total, 43 studies were included. In the pooled analysis, AF was significantly associated with dementia (adjusted OR, 1.6; 95% CI, 1.3 to 2.1; I2, 31%) and the combined endpoint of cognitive impairment or dementia (pooled adjusted OR, 1.5; 95% CI, 1.4 to 1.8; I2, 34%). The results were significant, even when studies including only stroke-free patients were pooled together (unadjusted OR, 2.2; 95% CI, 1.4 to 3.5; I2, 96%), but the heterogeneity rates were high. AF was significantly associated with increased risk of both vascular (adjusted OR, 1.7; 95% CI, 1.2 to 2.3; I2, 43%) and Alzheimer's dementia (adjusted HR, 1.4; 95% CI, 1.2 to 1.6; I2, 42%).

Conclusion: AF increases the risk of cognitive impairment, all-cause dementia, vascular dementia, and Alzheimer's disease. Future studies should employ interventions that may delay or even prevent cognitive decline in AF patients.

Keywords: atrial fibrillation; dementia; meta-analysis; systematic review.

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Conflict of interest statement

The authors declare that they do not have a conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow chart. The selection process is reported according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.
Figure 2
Figure 2
Publication bias assessment. Funnel plot with pseudo 95% confidence limits. Log, logarithm.
Figure 3
Figure 3
Meta-analysis results. Forest plot demonstrating pooled unadjusted odds ratio for dementia. Afib, atrial fibrillation; CI, confidence interval.
Figure 4
Figure 4
Sensitivity analysis. Forest plot demonstrating pooled adjusted hazard ratio including only prospective studies. Afib, atrial fibrillation; CI, confidence interval.
See this image and copyright information in PMC

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