Post-Stroke Atrial Fibrillation Increases Risk for Cognitive Deficits

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Poststroke, patients with atrial fibrillation had significantly worse outcomes associated with memory.
Poststroke, patients with atrial fibrillation had significantly worse outcomes associated with memory.

The presence of atrial fibrillation (AF) increases the risk for poststroke cognitive impairment (PSCI), regardless of whether or not treatment for AF-associated infarcts is performed, according to a study published in the Journal of Alzheimer's Disease.

Investigators evaluated cognitive deficits after mild ischemic stroke in 445 patients. A total of 80 (18.0%) patients presented with AF, and 217 (48.8%) patients had PSCI. Overall, patients with AF were older, were less likely to smoke, were less educated, and had higher rates of ischemic heart disease and hypertension compared with patients without AF.

After adjustment for other risk factors, the researchers found that the risk of developing PSCI was significantly higher among patients with AF compared with patients without AF, even after treatment of infarcts (odds ratio, 2.31; 95% CI, 1.12-4.75; P =.023. Patients with AF also had significantly worse outcomes associated with memory, as assessed by the 10-word immediate recall (P =.001) and 10-word delayed recall (P =.004).

In addition, patients with AF had worse executive function outcomes compared with patients without AF, as evaluated by the Frontal Assessment Battery (P =.004). Patients with AF also had lower cognitive scores, as assessed by the Mini-Mental State Examination (P <.001).

The relatively small sample size represents the most significant limitation of the researchers' findings. Another limitation was the lack of data regarding the determination of AF burden duration in patients with a history of AF.

In an effort to produce more robust findings that may provide greater clinical utility in predicting PSCI in the AF and ischemic stroke populations, the investigators believe additional research should "look at the interaction between cumulative burden of AF and infarct volume in PSCI, and longitudinal cognitive deficits" after a stroke event.

Reference

Chander RJ, Lim L, Handa S, et al. Atrial fibrillation is independently associated with cognitive impairment after ischemic stroke [published online September 7, 2017]. J Alzheimers Dis. doi:10.3233/JAD-170313

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