Dementia in subjects with atrial fibrillation: hemostatic function and the role of anticoagulation.

Abstract

BACKGROUND:

Atrial fibrillation (AF) is associated with cognitive impairment and dementia, perhaps through encouraging a prothrombotic state and cardioembolism.

OBJECTIVES:

We wished to test the hypotheses that hemostatic function is altered in subjects with AF who develop dementia, and that long-term warfarin anticoagulation is protective against this complication.

PATIENTS AND METHODS:

Recruitment was from an observational cohort study of AF. Baseline assessment included measurement of plasma fibrinogen, fibrin D-dimer, prothrombin fragment 1+2 (F1+2), thrombin-antithrombin complexes (TAT), von Willebrand factor and tissue plasminogen activator. We assessed cognitive function after 3 years' follow-up using the 13-item modified Telephone Interview for Cognitive Status (TICSm) and the short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE).

RESULTS:

Of the 218 subjects assessed, 145 (66%) were prescribed warfarin. Forty-nine (22%) met TICSm/IQCODE criteria for dementia. D-dimer, F1+2 and TAT levels were higher in AF subjects with dementia compared with those without (medians 81 vs. 60 ng mL(-1), P = 0.008; 0.76 vs. 0.49 nmol L(-1), P = 0.006; and 1.78 vs. 1.44 microg L(-1), P = 0.003, respectively). These associations became of borderline statistical significance following adjustment for age. Logistic regression showed a trend towards warfarin use being independently associated with reduced prevalence of dementia (odds ratio 0.52, P = 0.08).

CONCLUSIONS:

We found evidence of increased thrombin generation and fibrin turnover in subjects with AF and dementia compared with those without dementia. Long-term warfarin use may be protective against the development of dementia in subjects with AF.

• Authors: M Barber, R C Tait, J Scott, A Rumley, G D O Lowe, D J Stott
• Journal: Journal of thrombosis and haemostasis : JTH (J Thromb Haemost) Vol. 2 Issue 11 Pg. 1873-8 (Nov 2004) ISSN: 1538-7933 [Print] England
• PMID: 15550013 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anticoagulants
• Biomarkers

Topics

• Aged
• Aged, 80 and over
• Anticoagulants (pharmacology, therapeutic use)
• Atrial Fibrillation (blood, complications, drug therapy)
• Biomarkers (blood)
• Cohort Studies
• Dementia (blood, etiology, prevention & control)
• Drug Evaluation
• Female
• Follow-Up Studies
• Hemostasis (drug effects, physiology)
• Humans
• Logistic Models
• Male
• Predictive Value of Tests
• Prevalence
• Surveys and Questionnaires