Cognitive function and working memory assessment using the REMEDES system in patients with atrial fibrillation
K Triantafyllou, D Tachmatzidis, M Meletidou, M I Mountourli, S E Konstantinidou, S C Zagalioti, A Zgouridou, M Toumpourleka, G Giannopoulos, V VassilikosAbstract
Background/Introduction
Atrial fibrillation is strongly associated with cognitive decline and increased risk of dementia, but the cognitive domains that are most affected have not yet been fully elucidated. The most widely used neuropsychological tests [i.e. Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE)] can assess the general levels of cognitive function. Moreover, they are influenced by the social and demographic characteristics of the examinee, and typically lead to delayed diagnosis. The REMEDES for Alzheimer (R4Alz) battery, based on the REMEDES system, is a new tool that can efficiently identify cognitive decline in specific domains (working memory, attention, inhibitory control, and executive function) in a timely manner.
Purpose
To assess cognitive function and working memory in patients with atrial fibrillation.
Methods
The population of this cross-sectional observational study consisted of patients with atrial fibrillation, without a history of stroke,and adjusted healthy controls, with comparable clinical characteristics. Demographic and clinical data were collected, and all participants underwent the MoCA and R4Alz cognitive tests during a single visit. The primary endpoint was the difference in psychometric test performance between the two groups.
Results
139 patients with a history of atrial fibrillation (paroxysmal: 65.5%, persistent: 18%, permanent: 16.5%) and 69 healthy controls were included in the study (mean age: 61.5 years, women: 49.5%). Significant differences were observed between the two groups in terms of performance on the MoCA test (25.1 ± 3.8 vs. 26.3 ± 4.3, p = 0.002) (Picture 1), but also in the R4Alz working memory tests (WMCUT 1: 17 ± 3.6 vs. 19.4 ± 4.5, p < 0.001, WMCUT 2: 16.3 ± 4 vs. 18.6 ± 4.1, p < 0.001, WMCUT: 33.3 ± 7.3 vs. 38 ± 8.2, p < 0.001) (Picture 2). Performance on the two tests showed a statistically significant positive correlation (r = 0.60, p < 0.001).
Conclusions
Atrial fibrillation is associated with reduced performance in the cognitive domain of working memory, to a proportional degree to the reduction in general cognitive functioning. Newer psychometric batteries which assess specific cognitive domains may lead to earlier and more accurate diagnosis of cognitive dysfunction in patients with atrial fibrillation.