The pathophysiology of dementia remains incompletely understood, and there are conflicting findings regarding the contribution of atrial fibrillation (AF) to cognitive decline. Additionally, oral anticoagulants may influence the progression of dementia. This study aims to explore whether AF is associated with the progression
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The pathophysiology of dementia remains incompletely understood, and there are conflicting findings regarding the contribution of atrial fibrillation (AF) to cognitive decline. Additionally, oral anticoagulants may influence the progression of dementia. This study aims to explore whether AF is associated with the progression of cognitive decline and functional deterioration in older adults with dementia. Additionally, it seeks to evaluate the potential impact of anticoagulant therapy on cognitive and functional decline. This observational retrospective study involved 179 older adults with dementia under the care of the University of Padua from 2015 to 2020. Each participant underwent a two-year observation period, during which cognitive function was assessed using the Mini-Mental State Examination (MMSE), and functional abilities were measured with the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scales. AF patients made up 29.6% of the sample. According to ANOVA test for repeated measures, no significant differences in MMSE scores were observed over time between the AF and nAF groups or across the three time points based on anticoagulant therapy type. However, individuals with nAF showed a more pronounced decline in IADL and ADL scores over time. Linear mixed model analysis revealed that Alzheimer’s dementia (-1.98, 95% CI: -3.16, -0.79; p = 0.001) and age (-0.09, 95% CI: -0.18, -0.00; p = 0.044) were significantly associated with MMSE decline. Significant predictors of IADL decline included male sex (-1.20, 95% CI: -1.77, -0.64, p < 0.001), MMSE (0.15, 95% CI: 0.06, 0.25, p = 0.002), and age (-0.08, 95% CI: -0.13, -0.04, p < 0.001), with a notable interaction between nAF and time (-0.48, 95% CI: -0.86, -0.12, p = 0.010). For ADL, MMSE (0.15, 95% CI: 0.09, 0.22, p < 0.001), and age (-0.03, 95% CI: -0.07, -0.003, p < 0.001) were the main predictors. AF was not identified as a factor associated with cognitive decline when accounting for other variables. Instead, age and the presence of Alzheimer’s disease emerged as key factors linked to functional and cognitive deterioration.
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