1. Among older adults with atrial fibrillation with no cognitive compromise at baseline, there was no statistical difference between warfarin or dabigatran groups in cognitive outcomes.

Evidence Rating Level: 1 (Excellent)

Atrial fibrillation has been shown to be associated with an increased risk of cognitive decline and dementia, which is concerning given its higher prevalence and incidence among older adults. Certain theories surrounding this presentation may be related to silent brain infarctions, cerebral microbleeds, and hypoperfusion. Effective therapeutic strategies for atrial fibrillation in this population are needed; however, there remains a paucity of information on this topic and its potential relation to cognitive function. In this randomized clinical trial, 200 participants were randomized to receiving either dabigatran or warfarin. A thorough and comprehensive cognitive evaluation was performed at baseline and at 24 months assessing various cognitive domains. These tests included the Mini-Mental Status Examination (MMSE), the Montreal Cognitive Assessment (MoCA), a neuropsychological test battery (NTB), and computer-generated neuropsychological tests (CGNT). The results showed that after controlling for age, education, and raw baseline score, the difference in mean change of cognitive function was not statistically significant between the two groups with respect to MMSE, MoCA, NTB, and CGNT scores (mean difference -0.12, 95%CI -0.88-0.86; mean difference -0.96, 95%CI -1.80-0.13; mean difference -0.05, 95%CI -0.07-0.18; mean difference -0.15; 95%CI -0.30-0.006, respectively). In conclusion, this randomized clinical trial confirms that in older adults with atrial fibrillation without cognitive impairment at baseline, no difference in cognitive outcomes was identified between dabigatran and warfarin groups. However, there are some limitations in this study to note. For instance, given the small sample size of this study, its power is limited, and these findings cannot be generalized to the broader population. Additionally, this paper examined cognitive outcomes after 24 months, although an extended follow-up period may be needed to assess the long-term impacts of these anticoagulants. Nevertheless, this randomized clinical trial was the first of its kind to compare anticoagulants in older adults and assess for cognitive outcomes and further studies with larger population sizes should be conducted to confirm these results.

Click to read the study in BMC Medicine

Image: PD

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