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. 2024 Jul 14;13(14):4117.
doi: 10.3390/jcm13144117.

The Risk of Atrial Fibrillation and Previous Ischemic Stroke in Cognitive Decline

Tunde Pal  1 , Dragos-Florin Baba  2 , Zoltan Preg  3   4 , Eniko Nemes-Nagy  5   6 , Kinga-Ilona Nyulas  7 , Marta German-Sallo  4   8
Affiliations

The Risk of Atrial Fibrillation and Previous Ischemic Stroke in Cognitive Decline

Tunde Pal et al. J Clin Med. .

Abstract

Objectives: Our study investigated the inverse relationship between cognitive decline (CD) and the presence of documented atrial fibrillation (AFib), ischemic stroke, heart failure, lower extremity peripheral artery disease, and diabetes mellitus. Methods: We conducted a retrospective cross-sectional study between December 2016 and November 2019. A total of 469 patients were enrolled who underwent cognitive evaluation with three cognitive tests (Montreal Cognitive Assessment-MOCA, Mini-Mental State Examination-MMSE, and General Practitioner Assessment of Cognition-GPCOG). We used the standard cut-off values, and the optimal thresholds were obtained from the receiver operating characteristic curves. Results: The standard cut-off level of the MOCA (<26 points) was associated with the presence of AFib (OR: 1.83, 95% CI: 1.11-3.01) and the optimal cut-off level with <23 points with ischemic stroke (OR: 2.64, 95% CI: 1.47-4.74; p = 0.0011). The optimal cut-off value of the MMSE (<28 points) was associated with the presence of ischemic stroke (OR: 3.07, 95% CI: 1.56-6.07; p = 0.0012), AFib (OR: 1.65, 95% CI: 1.05-2.60; p = 0.0287), and peripheral artery disease (OR: 2.72, 95% CI: 1.38-5.36; p = 0.0039). GPCOG < 8 points were associated with ischemic stroke (OR: 2.18, 95% CI: 1.14-4.14; p = 0.0176) and heart failure (OR: 1.49, 95% CI: 1.01-2.21; p = 0.0430). Conclusions: Our research highlighted the broader utility of cognitive assessment. The MOCA and MMSE scores proved to be associated with documented AFib. Higher cognitive test results than the standard threshold for CD of the MMSE, GPCOG, and lower MOCA scores represented risk factors for the presence of previous ischemic stroke.

Keywords: atrial fibrillation; cognitive decline; cognitive test; detection.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Overlapping prevalence of cognitive decline determined by cognitive tests. Abbreviations: GPCOG, General Practitioner Assessment of Cognition; MMSE, Mini-Mental State Examination; MOCA, Montreal Cognitive Assessment; N, number of patients.
Figure 2
Figure 2
ROC curve of MOCA, MMSE, and GPCOG scores for the presence of documented AFib (A) and previous ischemic stroke (B). AFib documented atrial fibrillation, GPCOG General Practitioner Assessment of Cognition, MMSE Mini-Mental State Examination, MOCA Montreal Cognitive Assessment, and ROC receiver operating characteristics.
Figure 3
Figure 3
ROC curve of CHA2DS2-VASc and CD test scores for detecting previously documented AFib (A) and ischemic stroke (B). AFib documented atrial fibrillation, CD cognitive decline, and ROC receiver operating characteristics.
Figure 4
Figure 4
Associations between CD tests and the presence of investigated diseases. AFib documented atrial fibrillation, GPCOG General Practitioner Assessment of Cognition, HF heart failure, MMSE Mini-Mental State Examination, MOCA Montreal Cognitive Assessment, OR odds ratio, and PAD lower extremity peripheral artery disease.
See this image and copyright information in PMC

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