Atrial fibrillation and early-onset cognitive decline: a multicenter 14-year cross-sectional analysis of 1,641 patients in North Macedonia
V Zhaku, A Georgiev, C Kerala, L PoposkaAbstract
Background
Atrial fibrillation (AF) and dementia are escalating global health challenges. While their association is documented, the age-specific risk and the impact of metabolic comorbidities remain under-explored. However, population-based data from Southeast Europe remain limited, that’s why this study evaluates the relationship between AF and dementia with an emphasis on age-stratified co-occurrence patterns.
Material and Methods
We performed a multicenter cross-sectional analysis including 1,641 individuals aged ≥50 years recruited from six cities between 2011–2024. Dementia was diagnosed using Mini-Mental State Examination (MMSE <25) combined with Clock Drawing Test positivity. Clinical variables included AF, hypertension, diabetes mellitus (DM), and heart failure (HF). Associations were evaluated using χ² testing and multivariable logistic regression adjusting for age and sex.
Results
Dementia was prevalent in 19.98% (n=328) of the total cohort. Among those with dementia, 25.9% had concurrent AF, compared to only 13.8% in the non-dementia group. AF was independently associated with dementia (OR 2.18, 95% CI 1.61–2.94). Diabetes mellitus demonstrated a moderate association (OR 1.32), while heart failure showed a weaker relationship (OR 1.28); hypertension was not independently predictive (OR 0.94). Age-stratified analysis revealed the highest proportional coexistence of AF and dementia in younger elderly groups (50–59 years: 33.3%; 60–69 years: 35.9%), decreasing in older populations (70–79 years: 20.4%; ≥80 years: 17.3%). Overall AF prevalence in the cohort was 16.2%, increasing to 25.9% among dementia patients. Males demonstrated a slightly higher combined disease burden than females.
Discussion and Conclusion
AF is associated with more than a twofold increased likelihood of dementia, particularly appearing as a catalyst for early-onset cognitive decline, independent of major cardiovascular comorbidities. These findings underscore the necessity for routine cognitive screening and aggressive cardiovascular risk management in AF patients, especially in younger age brackets.