Physicians' Academy for Cardiovascular Education

Persons with atrial fibrillation at increased risk of dementia

Association of Atrial Fibrillation With Cognitive Decline and Dementia Over 20 Years: The ARIC‐NCS (Atherosclerosis Risk in Communities Neurocognitive Study)

Literature - Chen LY, Norby FL, Gottesman RF, et al. - J Am Heart Assoc. 2018;7:e007301.

Introduction and Methods

Atrial fibrillation (AF) has been associated with an increased risk of stroke, heart failure, death. Evidence is inconsistent about a potential relationship with cognitive decline and dementia, due to limited follow-up [1]. This analysis of the ARIC study evaluated the associations of incident AF with cognitive change and dementia onset among black and white adults was, in a community-based cohort over 20 years.

ARIC is a predominantly biracial community-based, prospective, cohort study, including 15,792 men and women, aged 45-64 years at baseline or visit 1 (1987-1989) [2]. Baseline for the present analysis was visit 2 (1990-1992), at which the first cognitive data were collected. Of the 14,348 participants who attended visit 2, those not identified as black or white, those with prevalent AF, those with prevalent dementia or with race-gender specific lowest 5th percentile cognitive test scores, those missing or with uninterpretable ECGs, those missing cognitive scores, and those missing other covariates of interest were excluded, leaving a study sample of 12,515 participants.

The assessment of cognitive function was done with 3 neuropsychological tests:

The diagnosis of dementia was done during visit 5 (2011-2013), by an in-person assessment, using an algorithm as defined in the National Institute on Aging–Alzheimer’s Association work groups [6] and the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition [7]. Z scores standardized to visit 2 were calculated for each test, to be able to compare them, and the three Z-scores were then used to calculate the composite global cognitive Z score. Methods to account for attrition from the cohort during follow-up were used, which is important in quantifying the long-term relationship of AF to cognitive decline and dementia.

Main results


Incident AF is associated with both greater cognitive decline and increased risk of dementia, independent of clinical ischemic stroke. These results raise the question how cognitive decline and dementia may be delayed or prevented in AF patients. Research is warranted to identify appropriate treatment.


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Find this article online at J Am Heart Assoc

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