Atrial fibrillation incrementally increases dementia risk across all CHADS2 and CHA2DS2VASc strata in patients receiving long-term warfarin

Background Patients with atrial fibrillation (AF) are at higher risk for developing dementia. Warfarin is a common therapy for the prevention of thromboembolism in AF, valve replacement, and thrombosis patients. The extent to which AF itself increases dementia risk remains unknown. Methods A total 6030 patients with no history of dementia and chronically anticoagulated with warfarin were studied. Warfarin management was provided through a Clinical Pharmacy Anticoagulation Service. Patients were stratified by warfarin indication of AF (n = 3015) and non-AF (n = 3015) and matched by propensity score (+/- 0.01). Patients were stratified by the congestive heart failure, hypertension, age >75 years, diabetes, stroke (CHADS(2)) score calculated at the time of warfarin initiation and followed for incident dementia. Results The average age of the AF cohort was 69.3 +/- 11.2 years, and 52.7% were male; average age of non-AF cohort was 69.3 +/- 10.9 years, and 51.5% were male. Increasing CHADS(2) score was associated with increased dementia incidence, P trend =.004. When stratified by warfarin indication, AF patients had an increased risk of dementia incidence. After multivariable adjustment, AF patients continued to display a significantly increased risk of dementia when compared with non-AF patients across all CHADS(2) scores strata. Conclusions In patients receiving long-term warfarin therapy, dementia risk increased with increasing CHADS(2) scores. However, the presence of AF was associated with higher rates of dementia across all CHADS(2) score strata. These data suggest that AF contributes to the risk of dementia and that this risk is not solely attributable to anticoagulant use. Dementia may be an end manifestation of a systemic disease state, and AF likely contributes to its progression.