Abstract
BACKGROUND: Atrial fibrillation (AF) and dementia frequently coexist in older adults, yet the impact of anticoagulation on cognitive and clinical outcomes in this population remains uncertain. OBJECTIVE: To evaluate the effects of anticoagulation on cognitive and clinical outcomes in patients with AF and dementia. METHODS: This retrospective cohort study included 291 patients aged ≥65 years with AF and dementia, treated at a tertiary center between January 2020 and December 2024. Patients were grouped by anticoagulation status. Cognitive, functional outcomes (Mini-Mental State Examination [MMSE], Activities of Daily Living [ADL], Clinical Dementia Rating-Sum of Boxes [CDR-SB]) and clinical endpoints (all-cause mortality, hospitalization, major adverse cardiovascular events, and bleeding) were assessed over a median 28-month follow-up. RESULTS: Anticoagulated patients were younger (82.8 versus 85.1 years, p = 0.01). Anticoagulation was associated with slower cognitive/functional decline, with medium effect sizes, ΔMMSE mean difference: 2.0 points (95% CI: -3.5 to -0.4; p = 0.048), ΔADL mean difference: 10.9 points (95% CI: -19.6 to -2.3; p = 0.02), ΔCDR-SB mean difference: -1.4 points (95% CI: 0.4 to 2.4; p < 0.01). In multivariable Cox models, anticoagulation reduced hospitalization risk (HR 0.60; 95% CI: 0.43-0.84; p < 0.01) and all-cause mortality (HR 0.59; 95% CI: 0.40-0.88; p = 0.01). Benefits were most pronounced in very mild dementia and Alzheimer's disease. CONCLUSIONS: In this retrospective, confounder-adjusted study, anticoagulation was associated with slower cognitive/functional decline and lower hospitalization/mortality risk in AF and dementia patients. The findings warrant prospective research to investigate whether anticoagulation has disease-modifying effects in early-stage dementia.